Single versus dual antibiotic-loaded bone cement in hip fracture arthroplasty: a cohort study of 56,434 hip arthroplasties from the Dutch Arthroplasty Register
Acta Orthopaedica · 13 Aug 2026
† Impact is the editorial-priority score. All scores are out of 100. Clinical is a stored clinical-importance score from the earlier method; it has not been recalculated.
Why it matters
This is one of the largest real-world datasets addressing whether dual ALBC reduces infection after hip fracture arthroplasty, a question with major cost and antibiotic-stewardship implications for a very common procedure.
The evidence
This Dutch registry study of 56,434 cemented hip fracture arthroplasties compared single versus dual antibiotic-loaded bone cement (ALBC) for preventing periprosthetic joint infection. After adjustment, dual ALBC was not associated with lower all-cause revision (HR 1.2, CI 0.9-1.5), but was associated with a slightly higher rate of revision for infection (HR 1.6, CI 1.0-2.5) and mortality (HR 1.2, CI 1.1-1.2) compared with single ALBC. The authors attribute the mortality signal to residual confounding (dual ALBC likely used in frailer patients) rather than a true causal effect of the cement.
All-cause revision: Hazard ratio 1.2 (95% CI 0.9 to 1.5; units not reported). The interval includes no difference. This does not establish equivalence or rule out an important effect.
Why this rigour score?
Registry cohort (adjusted)
Methods at a glance
Recorded assessment- Confounding adjustmentPropensity scores
- Covariate balance confirmedMet
- Outcome assessors blindedNot reported
- Comparable start of follow-upMet
- Adequate statistical powerNot applicable
- Prospective registrationNot met
Not reported does not mean not done. Checks have different weights; this is not a count of boxes ticked.
How to read this assessment
The recorded methods are shown alongside the published score. A verified point-by-point calculation is not available for this version of the appraisal.
Checklist from the stored appraisal. “Not met” describes the recorded criterion; it does not always produce a deduction. This overview supports reading the full study.
For journal club
1.Given the lack of demonstrated infection-prevention benefit and higher cost, should surgeons who currently use dual ALBC routinely in hip fracture arthroplasty reconsider switching to single ALBC?
2.How should indication bias and unmeasured frailty be factored into decisions about cement selection for high-risk hip fracture patients while awaiting trial data like DAICY?
Original publication title
Single versus dual antibiotic-loaded bone cement in hip fracture arthroplasty: a cohort study of 56,434 hip arthroplasties from the Dutch Arthroplasty Register