Efficacy of antibiotic-impregnated cement in total hip replacement.

BACKGROUND AND PURPOSE Antibiotic-impregnated cement is used as a spacer or during re-implantation surgery for the treatment of infected total hip arthroplasties. The routine use of antibiotic-impregnated cement during primary or uninfected revision total hip arthroplasty remains controversial. With this meta-analysis of the published literature, we intended to assess efficacy and safety in the use of antibiotic-impregnated cement for uninfected arthroplasty. METHODS Following a detailed literature search, only studies reporting on the outcome of total hip replacement performed with antibiotic cement were included. Strict inclusion criteria were used and studies lacking sufficient sample size or critical data were excluded. 19 studies reporting on 36,033 hip replacements in 35,659 patients met the initial inclusion criteria. The main aim of the meta-analysis was to determine the rate of deep infection with and without the use of antibiotic cement, and to assess the revision rate and the ultimate survivorship of arthroplasty using antibiotic cement. RESULTS The rate of deep infection following primary total hip arthroplasty, at 1.2%, was significantly lower when antibiotic cement was used than when cement without antibiotics was used (2.3%). Similarly, the rate of deep infection following revision total hip arthroplasty when a standard combination of cement and antibiotic--or a custom-made combination of cement and antibiotic, depending on the results of culture--was used, was almost half of the rate of deep infection when no antibiotics were present in the cement. Overall, the survivorship was 98% (101 failures in 5,178 hips) for primary arthroplasty and 88% (100 failures in 855 hips) for revision arthroplasty. There were no reported adverse events or complications associated with the use of antibiotic-impregnated cement. INTERPRETATION The use of antibiotic-impregnated cement lowered the infection rate by approximately 50% in primary hip arthroplasty. For revisions of previously infected hips, combinations or culture-dependent antibiotics lowered infection rates by approximately 40%.