Antimicrobial prophylaxis in hip surgery: a systematic review


Total hip replacement (THR) has become one of the most successful and cost-effective operations ever introduced. As with all surgery, THR has associated risks, one of which is infection. Infection of a joint prosthesis can be devastating, increasing morbidity and hospitalisation. The role of antimicrobial prophylaxis in reducing infection rates is undisputed. This systematic review was undertaken to compare the evidence for efficacy and cost-effectiveness of antimicrobial prophylaxis used for patients undergoing a THR.


Antimicrobial prophylaxis is effective for the prevention of surgical wound infection in both THR and Total Knee Replacement (TKR) surgery. The efficacy of many of the regimens studied may be similar, and available data make it difficult to identify an optimal regimen. There is no convincing evidence to suggest that the new-generation cephalosporins are more effective at preventing postoperative wound infections in THR/TKR surgery than the first-generation cephalosporins. Similarly, there is no convincing evidence to suggest that extending the duration of a regimen beyond 24 hours postoperatively reduces the number of surgical wound infections following THR/TKR surgery. Single-dose or short-term administration is not only as effective as long-term administration, but will lower overall costs and may reduce the risk of toxicity and the development of bacterial resistance.

Conducted by: Anne-Marie Glenny1, Song F1

1. NHS Centre for Reviews and Dissemination, University of York


Glenny AM, Song F. Antimicrobial prophylaxis in total hip replacement: a systematic review. Health Technol Assess. 1999;3(21):1-57.

Bonke H, Schnater J, Kleijnen J, Raaymakersk E. Hemiarthroplasty or total hip replacement for femoral neck fractures: a preliminary report of a randomized trial. Hefte zur der Unfallchirurg 1999;272:176-7


Commissioned by the Department of Health