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Br Med J. 1979 March 17; 1(6165): 707–709.
PMCID: PMC1598803

Antibiotic prophylaxis in total hip replacement.


A controlled prospective trial to compare the efficacy of the antibiotics cephaloridine and flucloxacillin in preventing infection after total hip replacement was conducted at three hospitals. The antibiotic regimens began before surgery, cephaloridine being continued for 12 hours and flucloxacillin for 14 days afterwards. Over an 18-month period 297 patients undergoing a total of 310 hip replacements were entered into the trial and randomly allocated to one of the regimens. The follow-up period ranged from one to two and a half years. All operations were performed in conventional operating theatres; at two of the hospitals these were also used by various other surgical disciplines. Four patients developed deep infection, two having received the cephaloridine and two the flucloxacillin regimen. The overall rate of deep infection was therefore 1.3%. Thus three doses of cephaloridine proved to be as effective as a two-week regimen of flucloxacillin. Giving a prophylactic systemic antibiotic reduced the incidence of infection to a level comparable with that obtained in ultra-clean-air operating enclosures.

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Selected References

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  • Benson MK, Hughes SP. Infection following total hip replacement in a general hospital without special orthopaedic facilities. Acta Orthop Scand. 1975 Dec;46(6):968–978. [PubMed]
  • Harris J, Lightowler CD, Todd RC. Total hip replacement in inflammatory hip disease using the Charnley prosthesis. Br Med J. 1972 Jun 24;2(5816):750–752. [PMC free article] [PubMed]
  • Patterson FP, Brown CS. The McKee-Farrar total hip replacement. Preliminary results and complications of 368 operations performed in five general hospitals. J Bone Joint Surg Am. 1972 Mar;54(2):257–275. [PubMed]
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  • Sutherland R, Croydon EA, Rolinson GN. Flucloxacillin, a new isoxazolyl penicillin, compared with oxacillin, cloxacillin, and dicloxacillin. Br Med J. 1970 Nov 21;4(5733):455–460. [PMC free article] [PubMed]
  • Polk HC, Jr, Lopez-Mayor JF. Postoperative wound infection: a prospective study of determinant factors and prevention. Surgery. 1969 Jul;66(1):97–103. [PubMed]
  • Evans C, Pollock AV. The reduction of surgical wound infections by prophylactic parenteral cephaloridine. A controlled clinical trial. Br J Surg. 1973 Jun;60(6):434–437. [PubMed]
  • Pavel A, Smith RL, Ballard A, Larsen IJ. Prophylactic antibiotics in clean orthopaedic surgery. J Bone Joint Surg Am. 1974 Jun;56(4):777–782. [PubMed]
  • Finegold SM, Rosenblatt JE. Practical aspects of anaerobic sepsis. Medicine (Baltimore) 1973 Jul;52(4):311–322. [PubMed]

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