Evidence map›Paper›PMID 39954085›Full record

ArticleArchives of orthopaedic and trauma surgery2025

Increased rates of periprosthetic joint infection following hip hemiarthroplasty with clindamycin prophylaxis compared to cefazolin.

Nadav Graif, Nissan Amzallag, Assaf Kadar, Itay Ashkenazi, Shai Factor, Aviram Gold, Nimrod Snir, Yaniv Warschawski

Abstract readComparative Study
PubMed Publisher
In one paragraph

Article in Archives of orthopaedic and trauma surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Nadav GraifTel Aviv Sourasky Medical Center, Tel Aviv, Israel. ngraif@gmail.com.
Nissan AmzallagTel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Assaf KadarUniversity of Western Ontario, London, Ontario, Canada.
Itay AshkenaziTel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Shai FactorTel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Aviram GoldTel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Nimrod SnirTel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Yaniv WarschawskiTel Aviv Sourasky Medical Center, Tel Aviv, Israel.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeTo compare the efficacy of clindamycin versus cefazolin in preventing periprosthetic joint infection (PJI) in patients undergoing hip hemiarthroplasty (HA) for femoral neck fractures.

methodsThis retrospective cohort study included 1,139 patients aged ≥ 65 years who underwent HA for femoral neck fractures between January 2017 and October 2023. Patients received either Cefazolin + Gentamicin (n = 1001) or Clindamycin + Gentamicin (n = 138). Propensity score matching was performed at a 6:1 ratio, resulting in 828 patients in the cefazolin group and 138 in the clindamycin group. PJI rates, causative organisms, and mortality were compared. Multivariate logistic regression adjusted for potential confounders.

resultsThe PJI rate was significantly higher in the clindamycin group compared to the cefazolin group (7.2% vs. 3.5%, p = 0.042). Multivariate analysis confirmed that clindamycin prophylaxis was independently associated with increased PJI risk (adjusted OR = 2.41, 95% CI: 1.16-4.99, p = 0.018). Other independent risk factors for PJI included age (adjusted OR = 1.03 per year, 95% CI: 1.01-1.05, p = 0.045), diabetes mellitus (adjusted OR = 1.76, 95% CI: 1.10-2.81, p = 0.018), and surgery duration (adjusted OR = 1.07 per minute, 95% CI: 1.01-1.16, p = 0.035). Staphylococcus aureus was the most common pathogen, with no significant differences in bacterial distribution between the groups. No significant differences were found in 30-day or 1-year mortality rates.

conclusionClindamycin prophylaxis in hip hemiarthroplasty for femoral neck fractures is associated with a significantly higher risk of PJI compared to cefazolin. These findings support the preferential use of cefazolin in patients without contraindications and demonstrate the critical need for accurate assessment of reported beta-lactam allergies. Results suggest potential benefit from pre-operative allergy evaluation when feasible, as alternative prophylaxis choices may carry increased infection risk. Further research is needed to explore alternative prophylactic strategies for patients with beta-lactam allergies.

Indexed as

Anti-Bacterial AgentsAntibiotic ProphylaxisArthroplasty, Replacement, HipCefazolinClindamycinFemoral Neck FracturesHemiarthroplastyProsthesis-Related InfectionsAgedAged, 80 and overFemaleHumansMaleRetrospective StudiesRisk FactorsAnti-Bacterial AgentsCefazolinClindamycinCefazolinClindamycinHip hemiarthroplastyPeriprosthetic joint infectionPropensity score matchingProphylactic antibiotics

Identifiers

PMID39954085

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.