Incidence of deep sepsis in uncemented total hip arthroplasty using clean air facility as a function of antibiotic...

Eight hundred and twenty two uncemented primary total hip arthroplasties (THAs) were performed between September 1980 and December 1992. The population that underwent uncemented THA can be divided into two groups based on the perioperative antibiotic prophylaxis: group 1 contains 439 primary THAs from September 1980 to September 1987 without antibiotic prophylaxis; group 2 contains 383 primary THAs who received short-term cefamandole prophylaxis from October 1987 to December 1992. Laminar air-flow and whole-body exhaust suits were used during the whole period of this study. Both groups consisted of relatively young patients with a mean age of 53.8 years in group 1, and 54.3 years in group 2. Using Kaplan-Meier survivorship analysis, the estimated survival rate of sepsis-free hips in group 1 was 97.9% at one year, 97.6% at two years, and 97.4% at three and up to eleven years. In group 2 with antibiotic prophylaxis no deep infection occurred; the rate of sepsis-free hips at five years is 100%. Under clean air conditions, antibiotic prophylaxis significantly decreased the incidence of deep sepsis (p log-rank 0.004).