High-dose dual-antibiotic loaded cement for hip hemiarthroplasty

In contradiction to results from previous studies, Nickil R Agni and colleagues' Article1Agni NR Costa ML Achten J et al.High-dose dual-antibiotic loaded cement for hip hemiarthroplasty in the UK (WHiTE 8): a randomised controlled trial.Lancet. 2023; 402: 196-202Summary Full Text Full Text PDF PubMed Scopus (0) Google Scholar on the WHiTE 8 randomised controlled trial showed that high-dose dual-antibiotic loaded bone cement resulted in a similar risk of deep surgical site infection at 90 days post-operation compared with standard care single-antibiotic loaded bone cement for patients aged 60 years or older with intracapsular hip fractures treated with hip hemiarthroplasties. Although the authors presented several baseline characteristics associated with increasing incidence of surgical site infection following hip hemiarthroplasties, such as cigarette use, alcohol consumption, diabetes, and renal failures, in table 1,1Agni NR Costa ML Achten J et al.High-dose dual-antibiotic loaded cement for hip hemiarthroplasty in the UK (WHiTE 8): a randomised controlled trial.Lancet. 2023; 402: 196-202Summary Full Text Full Text PDF PubMed Scopus (0) Google Scholar they conducted subgroup analyses merely according to the included participants' age and sex (as noted in figure 2),1Agni NR Costa ML Achten J et al.High-dose dual-antibiotic loaded cement for hip hemiarthroplasty in the UK (WHiTE 8): a randomised controlled trial.Lancet. 2023; 402: 196-202Summary Full Text Full Text PDF PubMed Scopus (0) Google Scholar which warrants further clarification. Moreover, if possible, we suggest that the included participants' baseline information regarding other established risk factors associated with surgical site infection after hip hemiarthroplasties, such as chronic steroid use,2Gupta A Shin J Oliver D Vives M Lin S Incidence and risk factors for surgical site infection (SSI) after primary hip hemiarthroplasty: an analysis of the ACS-NSQIP hip fracture procedure targeted database.Arthroplasty. 2023; 5: 1Crossref PubMed Scopus (2) Google Scholar obesity (ie, a BMI >35 kg/m2Gupta A Shin J Oliver D Vives M Lin S Incidence and risk factors for surgical site infection (SSI) after primary hip hemiarthroplasty: an analysis of the ACS-NSQIP hip fracture procedure targeted database.Arthroplasty. 2023; 5: 1Crossref PubMed Scopus (2) Google Scholar),2Gupta A Shin J Oliver D Vives M Lin S Incidence and risk factors for surgical site infection (SSI) after primary hip hemiarthroplasty: an analysis of the ACS-NSQIP hip fracture procedure targeted database.Arthroplasty. 2023; 5: 1Crossref PubMed Scopus (2) Google Scholar, 3Zajonz D Brand A Lycke C et al.Risk factors for early infection following hemiarthroplasty in elderly patients with a femoral neck fracture.Eur J Trauma Emerg Surg. 2019; 45: 207-212Crossref PubMed Scopus (0) Google Scholar an intraoperative time less than 45 min or more than 90 min,2Gupta A Shin J Oliver D Vives M Lin S Incidence and risk factors for surgical site infection (SSI) after primary hip hemiarthroplasty: an analysis of the ACS-NSQIP hip fracture procedure targeted database.Arthroplasty. 2023; 5: 1Crossref PubMed Scopus (2) Google Scholar, 3Zajonz D Brand A Lycke C et al.Risk factors for early infection following hemiarthroplasty in elderly patients with a femoral neck fracture.Eur J Trauma Emerg Surg. 2019; 45: 207-212Crossref PubMed Scopus (0) Google Scholar, 4de Jong L Klem TMAL Kuijper TM Roukema GR Factors affecting the rate of surgical site infection in patients after hemiarthroplasty of the hip following a fracture of the neck of the femur.Bone Joint J. 2017; 99-B: 1088-1094Crossref PubMed Scopus (73) Google Scholar a pre-operative serum C-reactive protein concentration greater than 14 mg/L,3Zajonz D Brand A Lycke C et al.Risk factors for early infection following hemiarthroplasty in elderly patients with a femoral neck fracture.Eur J Trauma Emerg Surg. 2019; 45: 207-212Crossref PubMed Scopus (0) Google Scholar surgeons' experiences measured by the number of hemiarthroplasties performed per year,4de Jong L Klem TMAL Kuijper TM Roukema GR Factors affecting the rate of surgical site infection in patients after hemiarthroplasty of the hip following a fracture of the neck of the femur.Bone Joint J. 2017; 99-B: 1088-1094Crossref PubMed Scopus (73) Google Scholar and comorbidities (including peripheral vascular disease, cerebrovascular disease, cancer without metastasis, and metastatic solid tumours),5Bourget-Murray J Horton I Morris J et al.Periprosthetic joint infection following hip hemiarthroplasty: factors associated with infection and treatment outcome.Bone Jt Open. 2022; 3: 924-932Crossref Scopus (4) Google Scholar should also be provided. Further subgroup analyses could be performed with these factors to identify subpopulations that might benefit from high-dose dual-antibiotic loaded bone cement and to enhance the clinical applicability of the study. We declare no competing interests. High-dose dual-antibiotic loaded cement for hip hemiarthroplasty – Authors' replyWe would like to thank Yi Liu and colleagues, Yang Liu and Hua Fa, and Po-Jui Chu and colleagues for their Correspondences about our WHiTE 8 trial.1 Regarding long-term follow-up, Liu and colleagues raise an important point. Nearly all the literature pertaining to long-term outcomes following deep surgical site infection around a hip arthroplasty comes from planned surgery, most commonly hip replacement for arthritis.2 These reports show that deep surgical site infection has implications for patients in the long term. Full-Text PDF