To compare the risk of periprosthetic joint infection (PJI) within 90 days after primary total hip arthroplasty (THA) for osteoarthritis among patients receiving a single preoperative prophylactic antibiotic dose and those receiving multiple doses.
Approach:
Study Design: A comparative effectiveness study designed to emulate a nationwide target trial using Danish registry data.
Data Sources: Linked Danish health registries provided information on THA procedures, antibiotic prophylaxis, comorbidities, and infection outcomes.
Cohort Definition: The study included patients in Denmark who underwent primary THA for osteoarthritis from January 1, 2010, through December 31, 2020, subject to specified exclusion criteria.
Outcome Measures: The primary outcome was PJI within 90 days after THA. Secondary outcomes included likely PJI defined using specified criteria.
Key Findings:
PJI is a serious complication of THA that can require further surgery and increase healthcare use.
Antibiotic prophylaxis dosing practices for THA vary, and contemporary evidence comparing dosing strategies is limited.
The study used a validated algorithm to identify PJI in registry data.
Interpretation:
The study’s findings suggest that a single preoperative prophylactic antibiotic dose may be a reasonable alternative to multiple doses for primary THA, without an increased risk of PJI within 90 days. The authors emphasize that the results should be interpreted cautiously because the study was observational and relied on registry-based outcome ascertainment.
Limitations:
Earlier studies had limited statistical power and included heterogeneous populations.
Registry data may not capture all infections, and diagnostic codes may be misclassified.
Conclusion:
The authors concluded that a single preoperative dose of antibiotic prophylaxis was not associated with a higher 90-day risk of PJI than multiple doses after primary THA for osteoarthritis. They considered single-dose prophylaxis a potential alternative to multiple-dose regimens, while noting that the observational design and registry-based outcome ascertainment limit causal conclusions.
Operative-time–adjusted findings favored the ipsilateral technique, while absolute fluoroscopy time and radiation exposure remained similar between approaches.
Randomized trial finds a topical anti-inflammatory patch provided similar pain relief, function, and safety as oral therapy during the first 6 weeks after surgery.
