title: 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.
abstract: 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.
authors.affiliation: Department of Orthopaedic Surgery, Department of Surgical Sciences, University of Bergen. Bergen, NO-5021, Norway. Lars.Engeseter@helse-bergen.no
authors.forename: Lars B
authors.initials: LB
authors.lastname: Engesaeter
authors.forename: Birgitte
authors.initials: B
authors.lastname: Espehaug
authors.forename: Stein Atle
authors.initials: SA
authors.lastname: Lie
authors.forename: Ove
authors.initials: O
authors.lastname: Furnes
authors.forename: Leif Ivar
authors.initials: LI
authors.lastname: Havelin
mesh_terms: 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
chemical_list: D000890:Anti-Infective Agents; D001843:Bone Cements