Impact of antibiotic-loaded bone cement prophylaxis on infection rates after curettage and cementation for bone tumor

Background: Infection rates post-surgery differ markedly between routine orthopaedic procedures and bone tumor surgeries, the latter significantly raising morbidity rates. Numerous strategies are being employed to decrease the infection rate in bone tumor surgeries. This study evaluates the effectiveness of antibiotic-loaded bone cement (ALBC) in reducing infection rates after curettage and cementation. Material and methods: This was a retrospective cohort study, including patients who were diagnosed with bone tumors and underwent curettage and cementation with or without fixation. Patient characteristics and perioperative specifics were collected from medical records, laboratory reports, operation reports, and outpatient follow-up databases. Surgical site infection (SSI) was defined following the criteria outlined by the Centers for Disease Control. Robust Poisson regression models, a frequently used multivariate technique under Generalized Linear Models with the Iterated Reweighted Least Squares algorithm, were used to measure the causal relationship. Results: In the cohort of 144 patients, six individuals (4.1%) developed SSI. Among them, 4 cases were superficial SSIs treated with antibiotics, and 2 cases were deep SSIs requiring surgical intervention. There was a significant difference in the incidence of SSI observed when comparing plain bone cement with ALBC, the latter showed a reduced risk, with a risk ratio of 0.06 (95% confidence interval: 0.006–0.61). Four factors were associated with SSI, including giant cell tumor of bone (GCTB), smoking, distal tumor location, and low serum albumin level. The type of antibiotic (Cefazolin vs. Clindamycin plus ceftazidime vs. Ceftriaxone) or the duration of intravenous antibiotic prescription did not impact the prevention of SSI. Conclusions: Our study reveals that ALBC may reduce the risk of SSI in curettage and cementation procedures. Additionally, the study identified independent risk factors for SSI, including GCTB, smoking, distal tumor location, and low serum albumin levels. Level of evidence: III.