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Collagen-gentamicin sponges do not reduce SSI after hemiarthroplasty
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Locally administered collagen-gentamicin sponges did not appear to decrease the incidence of surgical site infections in patients following hemiarthroplasty, according to recent findings.
“Surgical site infection is a feared complication in hip arthroplasty, especially following femoral neck fracture in the elderly, associated with substantially increased morbidity, mortality and costs,” the researchers wrote in Clinical Infectious Diseases. “Due to the serious course of a surgical site infection, prevention efforts are essential.”
In a multicenter, single-blinded, randomized trial, the researchers evaluated 684 elderly patients presenting to one of five hospitals in Norway with a displaced femoral neck fracture. Following hemiarthroplasty joint replacement surgery, patients were randomly assigned to routine intravenous prophylaxis and perioperative application of two gentamicin-containing collagen sponges into the hip joint (n=329) perioperatively or routine prophylaxis only (n=355).
The study’s primary outcome was surgical site infection (SSI) within 30 days of surgery. All SSIs and major complications were chronicled during the postoperative stay or upon patient readmission. Patients were seen for follow-up 4 weeks after treatment, or were contacted by phone when unavailable.
The researchers found no difference in SSI prevalence between the patients receiving gentamicin-collagen sponges (4.9%) compared those receiving routine intravenous prophylaxis alone (5.4%; RR = 0.91; 95% CI, 0.48-1.79).
Similar results were seen when limiting analysis by infection type. Superficial SSI incidence was 0.6% in the gentamicin-collagen group compared to 0.8% in the control group (P = 1.00), while deep and superficial SSI was 4.3% and 4.5%, respectively (P = .87). Additionally, the groups did not differ significantly in terms of the type of bacteria identified.
“To our knowledge, this is the first RCT on prophylactic use of collagen-gentamicin sponges in joint replacement surgery,” the researchers wrote. “Adding collagen-gentamicin sponges did not [significantly] reduce the SSI rate in patients undergoing hemiarthroplasty following femoral neck fracture.” – by Jen Byrne
Disclosure: The researchers report no relevant financial disclosures.
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