Nineteen studies (n=36,033 hips) met the inclusion criteria, but the authors stated that 13 were subsequently excluded from the meta-analysis because they did not have a control group. There was a discrepancy between the number of studies stated by the authors as included in the meta-analysis and those presented in the forest plots. Of the six remaining studies stated to be included in the meta-analysis (n=24,661 total hip replacements), 3,224 hips were excluded from the meta-analysis for the following reasons: lost to follow up (n=1,081 hips); Boneloc cement used (n=1,990 hips); Simplex cement containing erythromycin and colistin used (n=145 hips); and Simplex cement containing erythromycin only used (n=8 hips). Thus, 21,437 hips performed with or without the use of gentamicin as the sole antibiotic were included in the meta-analysis. There was a small discrepancy of eight hips between the number of hips included in the meta-analysis and the number stated by the authors.
Compared to non-antibiotic cement, antibiotic-impregnated cement was found to reduce the risk of infection after primary total hip arthroplasty (RR 0.506, p 0.001) and to reduce the risk of revision due to failure of primary total arthroplasty (RR 0.721, p<0.001).
There were no reported adverse effects of complications associated with the use of antibiotic-impregnated cement.