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What Is the Role of Local Antimicrobial Protection for One-Stage Revision for Peri-Prosthetic Hip Infection?

Carlo Luca Romanò1, Luigi Bonomo2, Giulio Bonomo2

  • 1Romano Institute, 1001 Tirana, Albania.

Antibiotics (Basel, Switzerland)
|November 27, 2024
PubMed
Summary

Local antimicrobial protection is safe for one-stage hip revision surgery, but evidence for its effectiveness is limited. More research is needed to confirm its role in preventing infection recurrence after hip revision procedures.

Keywords:
PJIantibacterial coatingshipinfectionlocal antibioticsone stageprosthesisreviewrevisionsingle stage

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Area of Science:

  • Orthopedic Surgery
  • Infectious Disease Prevention
  • Biomaterials Science

Background:

  • Hip revision surgery aims to address complications from primary hip replacements.
  • Infection remains a significant concern, particularly in complex revision procedures.
  • Local antimicrobial protection strategies are employed to mitigate infection risk.

Purpose of the Study:

  • To review the efficacy of local antimicrobial protection in one-stage cemented and cementless hip revision surgery.
  • To evaluate infection recurrence rates associated with different antimicrobial strategies.
  • To identify gaps in the evidence regarding local antimicrobial use in hip revision.

Main Methods:

  • Systematic review of twelve studies on cemented hip revision (minimum two-year follow-up).
  • Analysis of seventeen studies on cementless hip revision (minimum two-year follow-up).
  • Data pooling to assess infection recurrence rates with and without local antimicrobial protection.

Main Results:

  • For cemented revision, infection recurrence averaged 83.3%; studies without antibiotic-loaded bone cement showed higher control (95.9%).
  • For cementless revision, average infection recurrence was 90.0%; local antimicrobial protection showed a trend towards better control (90.1%-100%) versus without (86.7%).
  • No statistically significant difference was found between strategies, and no side effects were reported.

Conclusions:

  • Local antimicrobial protection is safe in one-stage hip revision surgery.
  • Current evidence relies heavily on expert opinion and lacks prospective/comparative trials.
  • Definitive conclusions on the effective role of local antimicrobials in one-stage hip revision cannot be drawn yet.