REDUCED RISK FOR PERIPROSTHETIC JOINT INFECTION AFTER REVISION ARTHROPLASTY WHEN USING DUAL ANTIBIOTIC-LOADED BONE CEMENT: A SWEDISH ARTHROPLASTY REGISTER-BASED STUDY ON 8,542 PATIENTS

Introduction & Aim To reduce the risk of periprosthetic joint infections (PJI), single antibiotic-loaded bone cement (SALBC) has long been used instead of plain bone cement 1 . Dual antibiotic-loaded bone cement (DALBC) has been proposed to provide enhanced antimicrobial coverage, and several studies have suggested a potential advantage over SALBC 2,3 , particularly in patients more susceptible to infection 4 . However, the evidence remains inconclusive. Patients undergoing hip or knee revision arthroplasty represents a high-risk group for PJI 5 . Despite indications that DALBC may offer a greater prophylactic effect in high-risk patients, its effectiveness compared with SALBC in revision arthroplasty has not been specifically established. This study aimed to evaluate whether DALBC reduces the risk of PJI compared with SALBC in patients undergoing hip or knee revision arthroplasty. Methods Data from the Swedish hip and knee arthroplasty registry yielded 8542 aseptic hip or knee revision arthroplasties performed between 2017 and 2023 where antibiotic-loaded bone cement was used. Kaplan–Meier survival analyses was performed to compare 1-year infection-free survival after hip or knee revision arthroplasty when either DALBC or SALBC was used. The risk of infection between the two groups was analysed using Cox regression analyses adjusting for relevant covariates such as sex, ASA class, and age. Results In all, 3,166 knee revision and 5,376 hip revision procedures were included. The one-year infection-free survival due to infection was 98% (95% CI 97.6 – 98.5) for the DALBC group and 96.9% (95% CI 96.4–97.4) for the SALBC group (p = 0.0015). Cox regression analysis revealed a statistically significant higher risk of infection for SALBC compared to DALBC (HR 1.69 95% CI 1.26 – 2.26, p < 0.001). When hip and knee procedures were analysed separately, SALBC was still associated with a higher risk of infection compared to DALBC in rTHA (HR 2.11, 95% CI 1.47 – 3.01, p < 0.001). No significant difference in infection risk was found between DALBC and SALBC in knee revision surgery (HR 1.04, 95% CI 0.63 – 1.73, p > 0.9). Conclusion Dual antibiotic-loaded bone cement appears to be protective against infection following cemented revision arthroplasty especially on hips. Based on these findings, our study supports the use of DALBC in revision hip arthroplasty.