Does cement increase the risk of infection in primary total hip arthroplasty? Revision rates in 56,275 cemented and uncemented primary THAs followed for 0-16 years in the Norwegian Arthroplasty Register.
BACKGROUND
The cementation of a total hip prosthesis may cause bone necrosis, either by direct toxicity or by generation of heat during the polymerization process. This necrotic bone may create conditions that encourage the growth of bacteria. We compared the revision rates due to infection in primary uncemented total hip arthroplasties (THAs) with those of cemented THAs with antibiotic-loaded cement and to those of cemented THAs without antibiotic cement.


METHODS
Data from the Norwegian Arthroplasty Register for the period 1987-2003 were used. To have comparable groups, we analyzed only primary THAs performed because of primary osteoarthrosis, and where both the acetabular and the femoral component of the prosthesis were either uncemented or cemented (n = 56,275).


RESULTS
In total, 252 revisions due to infection were reported. Compared to the uncemented THAs (n = 5,259), the risk of revision due to infection for THAs without antibiotic cement (n = 15,802) was increased 1.8 times (CI 1.0-3.1; p = 0.04). No differences could be detected when compared to THAs with antibiotic-loaded cement (n = 35,214) (RR 1.2, CI 0.7-2.0; p = 0.5). The average operating time for uncemented THAs was 15 min less than for cemented THAs.


CONCLUSIONS
The risk of revision due to infection was the same for uncemented and for cemented arthroplasties with antibiotic-loaded cement, but higher for cemented arthroplasties without antibiotic cement. Our findings can be explained by reduced resistance to infection caused by the cement, which appears to be neutralized by adding antibiotic to the cement.
Engesaeter
Lars B
LB
Department of Orthopaedic Surgery, Department of Surgical Sciences, University of Bergen. Bergen, NO-5021, Norway. Lars.Engeseter@helse-bergen.no
Espehaug
Birgitte
B
Lie
Stein Atle
SA
Furnes
Ove
O
Havelin
Leif Ivar
LI
D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000008:administration & dosage; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000379:methods; D001843:Bone Cements; D002484:Cementation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000601:surgery; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000209:etiology*; D012042:Registries; D012086:Reoperation; D012307:Risk Factors
D000890:Anti-Infective Agents; D001843:Bone Cements