TY - JOUR
T1 - Comparative effectiveness of antibiotic prophylaxis for preventing serious adverse events after primary total hip arthroplasty
T2 - a systematic review and network meta-analysis of randomized trials
AU - Abedi, Armita A.
AU - Svensson, Jacob M.
AU - Pedersen, Alma B.
AU - Varnum, Claus
AU - Nielsen, Sabrina M.
AU - Laigaard, Jens H.
AU - Christensen, Robin
AU - Overgaard, Søren
PY - 2025/8/19
Y1 - 2025/8/19
N2 - Background and purpose — The optimal duration of antibiotic prophylaxis for reducing serious adverse events (SAEs) after total hip arthroplasty (THA) is unclear. We aimed to assess the comparative effectiveness of different strategies of antibiotic prophylaxis in preventing SAEs after THA. Methods — We searched Medline, Embase, CENTRAL, and the Clinical Trial Registration Database for randomized controlled trials evaluating antibiotic prophylaxis in patients undergoing primary THA. Two authors independently screened, extracted data, and assessed the risk of bias. We defined SAEs as prosthetic joint infections, other serious infections, major cardiovascular events, venous thromboembolisms, or mortality. The primary summary measures were odds ratios (ORs) with 95% confidence intervals (CI). The evidence was assessed using the confidence in network meta-analysis (CINeMA) framework. Results — Of 6,131 identified citations, 10 trials of 2-group comparisons were included, involving 9,106 patients. Duration of antibiotics was grouped as follows: placebo (3), a single dose (3), multiple doses ≤ 24 hours (6), multiple doses (> 1 day) (6), and bone cement with antibiotics (2). Compared with placebo, point estimates suggest lower odds of SAEs after THA for most antibiotic strategies, except multiple doses > 1 day. Multiple doses showed no clear evidence of superiority to single dose: OR (multiple doses ≤ 24 hours) = 0.87 (CI 0.20–3.73; very low) or over more days (> 1 day) OR = 0.40 (CI 0.07–2.42; very low) nor were multiple doses > 1 day superior to multiple doses ≤ 24 hours, OR = 0.46 (0.11–1.90; very low). Conclusion — Relative to placebo, point estimates suggested that most antibiotic prophylaxis regimens may reduce SAEs after THA, with no clear evidence of added benefit from multiple doses. These findings should be interpreted with caution due to the lack of precision and the corresponding very low certainty of evidence for some comparisons.
AB - Background and purpose — The optimal duration of antibiotic prophylaxis for reducing serious adverse events (SAEs) after total hip arthroplasty (THA) is unclear. We aimed to assess the comparative effectiveness of different strategies of antibiotic prophylaxis in preventing SAEs after THA. Methods — We searched Medline, Embase, CENTRAL, and the Clinical Trial Registration Database for randomized controlled trials evaluating antibiotic prophylaxis in patients undergoing primary THA. Two authors independently screened, extracted data, and assessed the risk of bias. We defined SAEs as prosthetic joint infections, other serious infections, major cardiovascular events, venous thromboembolisms, or mortality. The primary summary measures were odds ratios (ORs) with 95% confidence intervals (CI). The evidence was assessed using the confidence in network meta-analysis (CINeMA) framework. Results — Of 6,131 identified citations, 10 trials of 2-group comparisons were included, involving 9,106 patients. Duration of antibiotics was grouped as follows: placebo (3), a single dose (3), multiple doses ≤ 24 hours (6), multiple doses (> 1 day) (6), and bone cement with antibiotics (2). Compared with placebo, point estimates suggest lower odds of SAEs after THA for most antibiotic strategies, except multiple doses > 1 day. Multiple doses showed no clear evidence of superiority to single dose: OR (multiple doses ≤ 24 hours) = 0.87 (CI 0.20–3.73; very low) or over more days (> 1 day) OR = 0.40 (CI 0.07–2.42; very low) nor were multiple doses > 1 day superior to multiple doses ≤ 24 hours, OR = 0.46 (0.11–1.90; very low). Conclusion — Relative to placebo, point estimates suggested that most antibiotic prophylaxis regimens may reduce SAEs after THA, with no clear evidence of added benefit from multiple doses. These findings should be interpreted with caution due to the lack of precision and the corresponding very low certainty of evidence for some comparisons.
KW - Antibiotic Prophylaxis
KW - Cemented Total Hip Arthroplasty
KW - Prevention
KW - Prosthetic Joint Infection
KW - Serious Adverse Events
UR - https://www.scopus.com/pages/publications/105015469027
U2 - 10.2340/17453674.2025.44482
DO - 10.2340/17453674.2025.44482
M3 - Review
C2 - 40827944
SN - 1745-3674
VL - 96
SP - 640
EP - 649
JO - Acta orthopaedica
JF - Acta orthopaedica
ER -