{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T07:27:17Z","timestamp":1786606037744,"version":"build-2736575974"},"reference-count":24,"publisher":"MJS Publishing, Medical Journals Sweden AB","license":[{"start":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:00:00Z","timestamp":1786579200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["ActaO"],"abstract":"<jats:p>Background and purpose:\u00a0Hip fracture treatment with (hemi)arthroplasty carries a risk of periprosthetic joint infection (PJI), which may be reduced by using dual antibiotic-loaded bone cement (ALBC). We aimed to compare the rate of all-cause revision, revision for infection, and mortality following single or dual ALBC use in hip fracture arthroplasty.Methods:\u00a0From the Dutch Arthroplasty Register, we identified all cemented hemiarthroplasties (HA) and total hip arthroplasties (THA) performed in the period 2007\u20132024 for proximal femoral fracture. Crude cumulative incidences of all-cause and infection revision were estimated using competing risk survival analyses with death as competing event. Mortality was estimated using Kaplan\u2013Meier analysis. Cause-specific Cox regression models adjusting for age, year of surgery, history of previous surgeries, and American Society of Anesthesiologists (ASA) classification estimated hazard ratios (HRs).Results:\u00a0We analyzed 56,434 hip arthroplasties, of which 1,651 used dual ALBC. 1-year crude cumulative incidences were similar across groups for all-cause revision, infection revision, and mortality. After adjustment, dual ALBC was not associated with a reduced rate of all-cause revision (HR 1.2, 95% confidence interval [CI] 0.9\u20131.5]) compared with single ALBC. Dual ALBC was associated with a modestly higher revision for infection (HR 1.6, CI 1.0\u20132.5) and mortality in HA (HR 1.2, CI 1.1\u20131.2).Conclusion:\u00a0Dual ALBC was not associated with lower revision rates compared with single ALBC but a modestly higher revision rate was noted for infection and mortality following hip arthroplasty after hip fracture.<\/jats:p>","DOI":"10.2340\/17453674.2026.46527","type":"journal-article","created":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T06:31:16Z","timestamp":1786602676000},"source":"Crossref","is-referenced-by-count":0,"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"],"prefix":"10.2340","volume":"97","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9404-0702","authenticated-orcid":false,"given":"Seung-Jae","family":"Yoon","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4107-3404","authenticated-orcid":false,"given":"Laura","family":"Van Marle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8141-842X","authenticated-orcid":false,"given":"Liza N","family":"Van Steenbergen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pieter K","family":"Bos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6022-2807","authenticated-orcid":false,"given":"Paul C","family":"Jutte","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7866-2467","authenticated-orcid":false,"given":"Marjan","family":"Wouthuyzen-Bakker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6410-3824","authenticated-orcid":false,"given":"Wierd P","family":"Zijlstra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1183","published-online":{"date-parts":[[2026,8,13]]},"reference":[{"key":"165604","doi-asserted-by":"crossref","unstructured":"Feng J N, Zhang C G, Li B H, Zhan S Y, Wang S F, Song C L. Global burden of hip fracture: the Global Burden of Disease Study. Osteoporos Int 2024; 35(1): 41-52. doi: 10.1007\/s00198-023-06907-3.","DOI":"10.1007\/s00198-023-06907-3"},{"key":"165605","unstructured":"Recommendations | Hip fracture: management | Guidance | NICE [Internet]. NICE; 2011 [cited 2026 Apr 1]. Available from: https:\/\/www.nice.org.uk\/guidance\/cg124\/chapter\/Recommendations#surgical-procedures"},{"key":"165606","doi-asserted-by":"crossref","unstructured":"O\u2019Connor M I, Switzer J A. AAOS Clinical Practice Guideline Summary: Management of hip fractures in older adults. J Am Acad Orthop Surg 2022; 30(20): e1291-6. doi: 10.5435\/JAAOS-D-22-00125.","DOI":"10.5435\/JAAOS-D-22-00125"},{"key":"165607","unstructured":"Proximale femurfracturen [Internet]. [cited 2026 Apr 1]. Available from: https:\/\/richtlijnendatabase.nl\/richtlijn\/proximale_femurfracturen\/proximale_femurfracturen_-_startpagina.html"},{"key":"165608","doi-asserted-by":"crossref","unstructured":"Lewis D P, W\u00e6ver D, Thorninger R, Donnelly W J. Hemiarthroplasty vs total hip arthroplasty for the management of displaced neck of femur fractures: a systematic review and meta-analysis. J Arthroplasty 2019; 34(8): 1837-43.e2. doi: 10.1016\/j.arth.2019.03.070.","DOI":"10.1016\/j.arth.2019.03.070"},{"key":"165609","doi-asserted-by":"crossref","unstructured":"Rogmark C, Viberg B, Wolf O, Mukka S, Costa M L, Gjertsen J E. An Acta Orthopaedica educational article: Femoral neck fractures in adults with emphasis on surgical treatment. Acta Orthop 2025; 96: 632-9. doi: 10.2340\/17453674.2025.44354.","DOI":"10.2340\/17453674.2025.44354"},{"key":"165610","doi-asserted-by":"crossref","unstructured":"Guren E, Figved W, Frihagen F, Watne L O, Westberg M. Prosthetic joint infection: a devastating complication of hemiarthroplasty for hip fracture. Acta Orthop 2017; 88(4): 383-9. doi:10.1080\/17453674.2017.1301009.","DOI":"10.1080\/17453674.2017.1301009"},{"key":"165611","doi-asserted-by":"crossref","unstructured":"Masters J, Metcalfe D, Ha J S, Judge A, Costa M L. Surgical site infection after hip fracture surgery: a systematic review and meta-analysis of studies published in the UK. Bone Joint Res 2020; 9(9): 554-62. doi: 10.1302\/2046-3758.99.BJR-2020-0023.R1.","DOI":"10.1302\/2046-3758.99.BJR-2020-0023.R1"},{"key":"165612","doi-asserted-by":"crossref","unstructured":"Agni N R, Costa M L, Achten J, Peckham N, Dutton S J, Png M E, et al. High-dose dual-antibiotic loaded cement for hip hemiarthroplasty in the UK (WHiTE 8): a randomised controlled trial. Lancet 2023; 402(10397): 196-202. doi: 10.1016\/S0140-6736(23)00962-5.","DOI":"10.1016\/S0140-6736(23)00962-5"},{"key":"165613","doi-asserted-by":"crossref","unstructured":"Sprowson A P, Jensen C, Chambers S, Parsons N R, Aradhyula N M, Carluke I, et al. The use of high-dose dual-impregnated antibiotic-laden cement with hemiarthroplasty for the treatment of a fracture of the hip: the Fractured Hip Infection trial. Bone Joint J 2016; 98-B(11): 1534-41. doi: 10.1302\/0301-620X.98B11.34693.","DOI":"10.1302\/0301-620X.98B11.34693"},{"key":"165614","doi-asserted-by":"crossref","unstructured":"Tyas B, Marsh M, Oswald T, Refaie R, Molyneux C, Reed M. Antibiotic resistance profiles of deep surgical site infections in hip hemiarthroplasty: comparing low dose single antibiotic versus high dose dual antibiotic impregnated cement. J Bone Jt Infect 2018; 3(3): 123-9. doi: 10.7150\/jbji.22192.","DOI":"10.7150\/jbji.22192"},{"key":"165615","doi-asserted-by":"crossref","unstructured":"Szymski D, Walter N, Krull P, Melsheimer O, Lang S, Grimberg A, et al. The prophylactic effect of single vs. dual antibiotic-loaded bone cement against periprosthetic joint infection following hip arthroplasty for femoral neck fracture: an analysis of the German Arthroplasty Registry. Antibiotics (Basel) 2023; 12(4): 732. doi: 10.3390\/antibiotics12040732.","DOI":"10.3390\/antibiotics12040732"},{"key":"165616","doi-asserted-by":"crossref","unstructured":"Png M E, Costa M, Nickil A, Achten J, Peckham N, Reed M R, et al. Cost-utility analysis of dual-antibiotic cement versus single-antibiotic cement for the treatment of displaced intracapsular hip fractures in older adults. Bone Joint J 2023; 105-B(10): 1070-7. doi: 10.1302\/0301-620X.105B10.BJJ-2023-0633.","DOI":"10.1302\/0301-620X.105B10.BJJ-2023-0633"},{"key":"165617","doi-asserted-by":"crossref","unstructured":"George J, Newman J M, Klika A K, Miller E M, Tan T L, Parvizi J, et al. Changes in antibiotic susceptibility of Staphylococcus aureus between the stages of 2-stage revision arthroplasty. J Arthroplasty 2018; 33(6): 1844-9. doi: 10.1016\/j.arth.2018.01.056.","DOI":"10.1016\/j.arth.2018.01.056"},{"key":"165618","doi-asserted-by":"crossref","unstructured":"Corona P S, Espinal L, Rodr\u00edguez-Pardo D, Pigrau C, Larrosa N, Flores X. Antibiotic susceptibility in gram-positive chronic joint arthroplasty infections: increased aminoglycoside resistance rate in patients with prior aminoglycoside-impregnated cement spacer use. J Arthroplasty 2014; 29(8): 1617-21. doi: 10.1016\/j.arth.2014.03.029.","DOI":"10.1016\/j.arth.2014.03.029"},{"key":"165619","unstructured":"Jaarrapportage [Internet]. [cited 2026 Mar 7]. Available from: https:\/\/www.lroi.nl\/jaarrapportage"},{"key":"165620","doi-asserted-by":"crossref","unstructured":"Savage P, McCormick M, Al-Dadah O. Arthroplasty infection rates in fractured neck of femur: single vs dual antibiotic cement. Ann R Coll Surg Engl 2019; 101(7): 514-8. doi: 10.1308\/rcsann.2019.0054.","DOI":"10.1308\/rcsann.2019.0054"},{"key":"165621","doi-asserted-by":"crossref","unstructured":"Mzeihem M, Rteil A, Koh J, Karam J A, Amirouche F. Evaluating the efficacy of dual versus single antibiotic-loaded bone cement in hip arthroplasty: a systematic review and meta-analysis. J Arthroplasty 2025; S0883-5403(25)01161-1. doi: 10.1016\/j.arth.2025.09.008.","DOI":"10.1016\/j.arth.2025.09.008"},{"key":"165622","doi-asserted-by":"crossref","unstructured":"Farrow L, Hudson J, George A, Reed M R, Campbell M K. High-dose dual antibiotic cement for hip hemiarthroplasty: a post-hoc Bayesian analysis of a randomized controlled trial. Bone Joint J 2025; 107-B(9): 957-64. doi: 10.1302\/0301-620X.107B9.BJJ-2024-1364.R1.","DOI":"10.1302\/0301-620X.107B9.BJJ-2024-1364.R1"},{"key":"165623","doi-asserted-by":"crossref","unstructured":"Mukka S, Hailer N P, M\u00f6ller M, Gordon M, Lazarinis S, Rogmark C, et al. Study protocol: the DAICY trial-dual versus single-antibiotic impregnated cement in primary hemiarthroplasty for femoral neck fracture\u2014a register-based cluster-randomized crossover-controlled trial. Acta Orthop 2022; 93: 794-800. doi: 10.2340\/17453674.2022.4819.","DOI":"10.2340\/17453674.2022.4819"},{"key":"165624","doi-asserted-by":"crossref","unstructured":"Schwarz E M, McLaren A C, Sculco T P, Brause B, Bostrom M, Kates S L, et al. Adjuvant antibiotic-loaded bone cement: concerns with current use and research to make it work. J Orthop Res 2021; 39(2): 227-39. doi: 10.1002\/jor.24616.","DOI":"10.1002\/jor.24616"},{"key":"165625","doi-asserted-by":"crossref","unstructured":"van Veghel M H W, Belt M, Spekenbrink-Spooren A, Kuijpers M F L, van der Kooi T II, Schreurs B W, et al. Validation of the incidence of reported periprosthetic joint infections in total hip and knee arthroplasty in the Dutch Arthroplasty Register. J Arthroplasty 2024; 39(4): 1054-9. doi: 10.1016\/j.arth.2023.10.040.","DOI":"10.1016\/j.arth.2023.10.040"},{"key":"165626","doi-asserted-by":"crossref","unstructured":"Lutro O, Mo S, Tj\u00f8rhom M B, Fenstad A M, Leta T H, Bruun T, et al. How good are surgeons at disclosing periprosthetic joint infection at the time of revision, based on pre- and intra-operative assessment? A study on 16,922 primary total hip arthroplasties reported to the Norwegian Arthroplasty Register. Acta Orthop 2024; 95: 67-72. doi: 10.2340\/17453674.2024.39914.","DOI":"10.2340\/17453674.2024.39914"},{"key":"165627","doi-asserted-by":"crossref","unstructured":"Christensen R, Ranstam J, Overgaard S, Wagner P. Guidelines for a structured manuscript: statistical methods and reporting in biomedical research journals. 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