Systematic Review and Meta-analysis of Randomized Controlled Trials of Antibiotics and Antiseptics for Preventing Infection in People Receiving Primary Total Hip and Knee Prostheses

Infection rates in primary (first-time) major joint arthroplasty continue to be a significant issue. The effect of antibiotic and anti-septic prophylaxis on outcomes for this type of surgery has not been adequately reviewed. A systematic search of the main data-bases for randomized controlled trials (RCTs) evaluating antibiotics and antiseptics was conducted to evaluate the predeter-mined endpoints of infection, adverse events, costs, quality of life, and concentration levels of antibiotics. A meta-analysis using pooled effect estimates and fixed-effect and random-effect models of risk ratios (RR), calculated with 95 % confidence intervals (CI), was utilized. Thirty (30) RCTs examined the effects of antibiotic and antiseptic prophylaxis on infections after primary to-tal hip arthroplasty (THA) (total of 11,597 participants) and total knee arthroplasty (TKA) (total of 6,141 participants). For THA, preoperative systemic intravenous (i.v.) antibiotic prophylaxis may be effective in reducing the incidence of infection after THA from 6months to>5 years. For TKA, there is no RCT evidence that antibiotics and/or antiseptics have any effect on infection rate. Preoperative systemic antibiotic prophylaxis in primary THAmay be effective at reducing infection rate. There is no evi-dence that timing, route of administration, or concentration levels have an effect on reducing infections, adverse events, or costs in THA or TKA. Many of the trials included in this study were published in the 1980s and 1990s. Thus, it would be important to replicate a number of them based on current patient demographics and incidence of bacterial resistance. Over 1.5 million primary total hip (THA) and knee (TKA)replacements (arthroplasties) are implanted annually world-wide (1). Additionally close to 1 million are performed in th