Norwegian registry antibiotic cement

Antibiotic prophylaxis in total hip arthroplasty: effects of antibiotic prophylaxis systemically and in bone cement on the revision rate of 22,170 primary hip replacements followed 0-14 years in the Norwegian Arthroplasty Register.

Engesaeter LB, Lie SA, Espehaug B, et al. Acta orthopaedica Scandinavica 2003 · PMID 14763692 · doi:10.1080/00016470310018135

Question

Does combining systemic antibiotic prophylaxis with antibiotic-loaded cement reduce revision after cemented total hip replacement?

Design

National arthroplasty registry analysis from Norway with up to 14 years of follow-up.

Patients

Over 22,000 primary cemented total hip replacements for osteoarthritis in the Norwegian Arthroplasty Register.

Intervention

Systemic antibiotics plus antibiotic-loaded cement

Comparison

Systemic antibiotic prophylaxis alone

Primary outcome

Revision for any cause, including infection and aseptic loosening

Key result

Combined systemic and cement antibiotic prophylaxis carried the lowest revision risk; systemic prophylaxis alone was associated with higher revision for any cause, aseptic loosening and infection. Within the combined regime, four systemic doses on the day of surgery performed best.

Limitations

Observational registry data are open to confounding, and revision is a blunt marker of infection that misses infections treated without revision.

Impact on practice

It is the classic evidence for using antibiotic-loaded cement alongside systemic prophylaxis in cemented arthroplasty, which is routine in the UK.