Antibacterial hydrogel coating is associated with lower complication risks after complex high-risk primary and cementless hip revision arthroplasty : a retrospective matched cohort study.

Aims: This study aimed to verify the hypothesis that an antibiotic-loaded hydrogel, defensive antimicrobial coating (DAC), reduces overall complication and infection rates when used for high-risk primary and revision total hip arthroplasty (THA).

Methods: This was a retrospective, 1:1 matched cohort study of 238 patients, treated with cementless implants coated with and without DAC. A subgroup analysis was also conducted of patients undergoing second-stage revision THA for periprosthetic joint infection (PJI). Reinfection rates within two years, complications necessitating surgical intervention, and radiological analysis for aseptic loosening were assessed.

Results: Overall, the mean age of the patients was 68.3 years (SD 11.5), with 39 (32.8%) McPherson class A, 64 (53.8%) class B, and 16 (13.4%) class C. Four (3.4%) patients in the DAC group developed complications including one PJI and one delayed wound healing, while 13 (10.9%) patients in the control group developed complications, including five PJIs and three delayed wound healing (p = 0.032). PJI rates (p = 0.136) and delayed wound healing rates (p = 0.337) were not statistically significant. For second-stage revision THA, for PJI there were 86 patients in the DAC group and 45 in the control group. One patient (1.2%) in the DAC group developed complications with no recurrences of infection or delayed wound healing, while ten patients (22.2%) in the control group developed complications including four recurrent PJI and one delayed wound healing (p = 0.003). Recurrent PJI rates were statistically significant (p = 0.005), while delayed wound healing rates were not (p = 0.165). Patients treated with DAC also had lower rates of aseptic loosening (0% compared with 6.7%; p = 0.015). No local or systemic side effects related to the DAC hydrogel coating were observed.

Conclusion: Antibiotic-impregnated hydrogel coatings on cementless implants appear to be associated with decreased complication rates after complex primary or revision THA. For second-stage revision THA for PJI, it is also associated with reduced risk of reinfection and aseptic loosening.