Evaluating the Efficacy of Dual Versus Single Antibiotic-Loaded Bone Cement in Hip Arthroplasty: A Systematic Review...

This study compared the effectiveness of dual antibiotic-loaded bone cement (DALBC) with that of single antibiotic-loaded bone cement (SALBC). The purpose was to evaluate the risk of surgical site infections (SSIs) after cemented hip arthroplasty, which included both hemiarthroplasty and total hip arthroplasty.

A systematic review and meta-analysis, conducted by the rigorous Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, ensured a comprehensive search across PubMed, Embase, and the Cochrane Library databases from inception to February 2025. This thorough process, including subgroup analyses based on procedure type, should instill confidence in the validity of the results. Data were pooled using a random effects model, and heterogeneity was assessed using the I² statistic. There were eight studies, comprising a total of 36,939 patients included, with 5,830 patients receiving DALBC and 31,109 patients receiving SALBC.

The use of DALBC was associated with a significantly lower risk of SSI compared to SALBC (odds ratio: 0.64; 95% confidence interval: 0.47 to 0.87; P < 0.001; I² = 26%). Subgroup analysis revealed this reduction was significant in hemiarthroplasty patients (odds ratio: 0.48; 95% confidence interval: 0.34 to 0.69; P < 0.001), whereas the difference was not statistically significant in total hip arthroplasty and revision total hip arthroplasty patients.

Dual antibiotic-loaded bone cement significantly reduces the risk of SSI following cemented hip hemiarthroplasty and overall hip arthroplasty. These findings support the consideration of DALBC in high-risk patients undergoing hip arthroplasty to optimize infection prevention and management.