Mohammed Cara, Sandhu Zuzanna, Cherukuri Anjani Mahesh Kumar, Khouri Jeries Sayegh Adeeb, Venkataramana Kuruba, Sahoo Aman Saswat, Jothilingam Kabilesh, Muhammed Seba Sayed, Elahi Zain, Ehsan Muhammad, Tuglo Lawrence Sena, Goalan Raakesh
Department of Orthopaedic Surgery, Sangre Grande Hospital, Sangre Grande, Trinidad and Tobago.
Department of Neurosciences, University Hospital Coventry & Warwickshire NHS Trust, Coventry, UK.
Orthop Surg. 2025 Jul;17(7):2103-2111. doi: 10.1111/os.70056. Epub 2025 Jun 2.
Antibiotic-loaded cement (ALC) is often used to reduce the risk of surgical site infections (SSIs) in hip hemiarthroplasty; however, controversy exists regarding the use of dual antibiotic-loaded cement (DALC) and single antibiotic-loaded cement (SALC).
This systematic review and meta-analysis compare the efficacy of DALC and SALC for hip hemiarthroplasty.
For this systematic review, a search was undertaken in the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, and ClinicalTrials.gov. Grey literature such as ProQuest Dissertations and Theses Global (PQDT) was also explored. The inclusion criteria comprised randomized controlled trials (RCTs) or comparative observational studies, and patients undergoing hip hemiarthroplasty with DALC or SALC. Newcastle-Ottawa Scale (NOS) and RoB 2.0 tools were used for risk of bias assessment in observational and RCTs, respectively. Review Manager (RevMan, version 5.4.1; The Cochrane Collaboration, Copenhagen, Denmark) was used for statistical analysis. The primary outcome was the incidence of deep SSIs.
A total of five articles, including 28,418 participants, met the inclusion criteria. Three of the included studies were retrospective studies, one quasi-randomized study, and one RCT. The primary outcome revealed that DALC was associated with a statistically significant reduction in deep SSIs compared to SALC (RR, 0.47; 95% CI, 0.29-0.76; p = 0.002; I = 27%). Subgroup analysis based on the study design did not show a significant difference for deep SSIs (p = 0.29). The majority of the secondary outcomes, such as superficial SSIs, mortality, participants with ≥ 1 complication, or antibiotic use, did not show any significant difference. However, DALC significantly lowered the risk of any infection (RR, 0.55; 95% CI, 0.38-0.79; p = 0.001; I = 27%).
In conclusion, DALC can significantly reduce the risk of SSIs and the overall rate of any infection in hip hemiarthroplasty. A limitation of this study is that RCTs were pooled with observational studies, which decreased the power of analysis. Therefore, further research, including large RCTs, is needed to validate these findings.
抗生素骨水泥（ALC）常用于降低髋关节半关节置换术手术部位感染（SSI）的风险；然而，关于使用双重抗生素骨水泥（DALC）和单一抗生素骨水泥（SALC）仍存在争议。
本系统评价和荟萃分析比较DALC和SALC在髋关节半关节置换术中的疗效。
对于本系统评价，在Cochrane对照试验中央注册库、MEDLINE、Embase和ClinicalTrials.gov进行了检索。还探索了灰色文献，如ProQuest学位论文和全球学位论文（PQDT）。纳入标准包括随机对照试验（RCT）或比较观察性研究，以及接受DALC或SALC髋关节半关节置换术的患者。分别使用纽卡斯尔-渥太华量表（NOS）和RoB 2.0工具对观察性研究和RCT中的偏倚风险进行评估。使用Review Manager（RevMan，版本5.4.1；丹麦哥本哈根Cochrane协作网）进行统计分析。主要结局是深部SSI的发生率。
共有5篇文章，包括28418名参与者，符合纳入标准。纳入的研究中，3项为回顾性研究，1项为准随机研究，1项为RCT。主要结局显示，与SALC相比，DALC与深部SSI的统计学显著降低相关（RR，0.47；95%CI，0.29-0.76；p = 0.002；I² = 27%）。基于研究设计的亚组分析未显示深部SSI有显著差异（p = 0.29）。大多数次要结局，如浅表SSI、死亡率、有≥1种并发症的参与者或抗生素使用，均未显示任何显著差异。然而，DALC显著降低了任何感染的风险（RR，0.55；95%CI，0.38-0.79；p = 0.001；I² = 27%）。
总之，DALC可显著降低髋关节半关节置换术中SSI的风险和任何感染的总体发生率。本研究的一个局限性是将RCT与观察性研究合并，这降低了分析效能。因此，需要进一步的研究，包括大型RCT，来验证这些发现。
