New Study Supports the Use of Dual Antibiotic-Loaded Bone Cement for Infection Prevention Following Femoral Neck Fracture

Cemented hemiarthroplasty is a common procedure in orthopedic surgery for treating femoral neck fractures (FNF). One of the most feared complications following hemiarthroplasty in FNF patients is periprosthetic joint infection (PJI).  

The use of antibiotic-loaded bone cement (ALBC) plays a key role in local infection prevention. Various studies have shown that high-dose, dual antibiotic-loaded bone cement (DALBC) can provide better local infection prophylaxis in hip surgeries than low-dose, single antibiotic-loaded bone cement (SALBC)^1-4. However, the largest study on this topic by Agni et al. (2023) did not provide statistical certainty to the extent of the positive effect on PJI reduction. 

The newly published study by Farrow et al. (2025), which re-analyzed the data from Agni et al. using a Bayesian statistical approach (see below for explanation), supports the use of DALBC which is associated with at least a 20% lower infection risk compared to SALBC with a confidence of at least 80%. These new findings are in line with a clear trend — based on both randomized and probabilistic studies — toward preferring high-dose, dual antibiotic-loaded bone cement (DALBC / COPAL® G+C) over single-loaded bone cement (SALBC) for infection prevention in hemiarthroplasty for femoral neck fractures.

The full study is available here:

Further background information on infection prevention in high-risk patients with femoral neck fractures, the use of dual antibiotic-loaded bone cement COPAL^® G+C, and relevant studies can be found on our website:

Abbreviations:  

• ALBC: Antibiotic-loaded bone cement 

• SALBC: Single antibiotic-loaded bone cement  

• DALBC: Dual antibiotic-loaded bone cement 

• FNF: Fractured neck of femur 

• PJI: Periprosthetic Joint Infection

Explanation „Bayesian trials“:  

Bayesian trials are based on a statistical paradigm called ‘Bayes’ Theorem’, which is used to estimate the conditional probability of an event. Calculations include use of previous knowledge – information known as ‘priors’⁵

Sources:  

Website Heraeus Medical, Clinical Topic “Fractured neck of femur”.
^1-4 Sprowson et al. (2016), Tyas et al. (2018), Savage et al. (2019), Agni et al. (2023).
⁵ Farrow et al. (2025), p 958.