What Is the Role of Local Antimicrobial Protection for One‐Stage Revision for Peri‐Prosthetic Hip Infection?

Antibiotic-loaded bone cement has been traditionally advocated as a key step for the success of one-stage hip revision surgery, while cementless techniques have been re-cently proposed with and without the use of local antibacterials as an equally suc-cessful alternative. Aim of this review is to investigate the effective role of local anti-microbial protection for one-stage cemented and cementless hip revision surgery. Twelve studies reporting the results of cemented single-stage procedure at a minimum two years follow-up were reviewed. When pooling together the data, no infection re-currence was observed on average in 83.3% of the patients (range 75.0% to 100%). Only two papers, both from the same French group, included patients treated without the use of antibiotic-loaded bone cement, with an average infection control of 95.9% in a total of 195 patients. This figure appears better that the 80.7% infection control ob-tained by pooling together all the remaining studies. Concerning cementless one-stage revision, a total of 17 studies, reporting on 521 patients, showed an average 90.0% (range 56.8% to 100%) no infection recurrence, at a minimum two years follow-up. Eight papers reported the outcomes of cementless implants without any local antibac-terial protection and nine more described four different techniques for local antimi-crobial implant protection. No comparative study investigated cementless revision with or without local antibacterial protection. Pooled data showed an average infection control of 86.7%, without the application of local antibacterials, compared to 90.1% to 100% with local antimicrobial protection, depending on the technology used. Howev-er, due to the relatively low number of patients treated with each local antimicrobial protection, no statistical difference could be found, either considering local antibacte-rial strategies alone or pooled together. No side effect had been reported by any local antibacterial technique. This review points out that local antibacterial protection for one-stage hip revision surgery, although safe and largely performed in the clinical set-ting, appears still to rely mainly on experts’ opinion and on observational series with no prospective or comparative trial, hence no definitive conclusion can be drawn con-cerning its effective role in one-stage hip revision surgery.