WHiTE 8 COPAL

High-dose dual-antibiotic loaded cement for hip hemiarthroplasty in the UK (WHiTE 8): a randomised controlled trial.

Agni NR, Costa ML, Achten J, et al. Lancet (London, England) 2023 · PMID 37354913 · doi:10.1016/s0140-6736(23)00962-5

Randomised trialPreventionOperative technique & equipmentCitation checked

Question: Does high-dose dual-antibiotic cement reduce deep surgical site infection compared with standard single-antibiotic cement in hip fracture hemiarthroplasty?
Design: Pragmatic multicentre RCT nested within the WHiTE platform cohort in UK NHS hospitals.
Patients: Older adults (60 and over) with an intracapsular hip fracture treated with cemented hemiarthroplasty.
Intervention: High-dose dual-antibiotic loaded cement (gentamicin plus clindamycin)
Comparison: Standard low-dose single-antibiotic loaded cement (gentamicin)
Primary outcome: Deep surgical site infection within 90 days
Key result: Deep surgical site infection did not differ significantly between high-dose dual-antibiotic and standard single-antibiotic cement.
Limitations: The infection rate was lower than anticipated, which limits power to detect small differences, and results apply to hemiarthroplasty for hip fracture rather than elective arthroplasty.
Impact on practice: It does not support routinely paying more for high-dose dual-antibiotic cement in hip fracture hemiarthroplasty. Standard antibiotic-loaded cement remains appropriate.