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Research

Postoperative antibiotic prophylaxis in total hip and knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials

Patrick Thornley, Nathan Evaniew, Michael Riediger, Mitchell Winemaker, Mohit Bhandari and Michelle Ghert
September 25, 2015 3 (3) E338-E343; DOI: https://doi.org/10.9778/cmajo.20150012
Patrick Thornley
Faculty of Health Sciences (Thornley), Michael G. DeGroote School of Medicine; Division of Orthopaedics (Evanview, Riediger, Winemaker, Bhandari, Ghert), Department of Surgery; Department of Clinical Epidemiology and Biostatistics (Bhandari), McMaster University, Hamilton, Ont.
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Nathan Evaniew
Faculty of Health Sciences (Thornley), Michael G. DeGroote School of Medicine; Division of Orthopaedics (Evanview, Riediger, Winemaker, Bhandari, Ghert), Department of Surgery; Department of Clinical Epidemiology and Biostatistics (Bhandari), McMaster University, Hamilton, Ont.
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Michael Riediger
Faculty of Health Sciences (Thornley), Michael G. DeGroote School of Medicine; Division of Orthopaedics (Evanview, Riediger, Winemaker, Bhandari, Ghert), Department of Surgery; Department of Clinical Epidemiology and Biostatistics (Bhandari), McMaster University, Hamilton, Ont.
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Mitchell Winemaker
Faculty of Health Sciences (Thornley), Michael G. DeGroote School of Medicine; Division of Orthopaedics (Evanview, Riediger, Winemaker, Bhandari, Ghert), Department of Surgery; Department of Clinical Epidemiology and Biostatistics (Bhandari), McMaster University, Hamilton, Ont.
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Mohit Bhandari
Faculty of Health Sciences (Thornley), Michael G. DeGroote School of Medicine; Division of Orthopaedics (Evanview, Riediger, Winemaker, Bhandari, Ghert), Department of Surgery; Department of Clinical Epidemiology and Biostatistics (Bhandari), McMaster University, Hamilton, Ont.
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Michelle Ghert
Faculty of Health Sciences (Thornley), Michael G. DeGroote School of Medicine; Division of Orthopaedics (Evanview, Riediger, Winemaker, Bhandari, Ghert), Department of Surgery; Department of Clinical Epidemiology and Biostatistics (Bhandari), McMaster University, Hamilton, Ont.
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    Figure 1

    Selection of randomized controlled trials for inclusion in the analysis. RCT = randomized controlled trial.

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    Figure 2

    Appraisal of risk of bias of the included trials using the Cochrane risk-of-bias tool.16

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    Figure 3

    Pooled analysis of the effect of postoperative antibiotic prophylaxis versus placebo or no treatment for the prevention of surgical-site infections in patients undergoing total hip or knee arthroplasty reported in randomized controlled trials. A risk difference of less than zero indicates a positive effect of postoperative antibiotic prophylaxis. CI = confidence interval.

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    Table 1: Characteristics of randomized controlled trials included in the meta-analysisof postoperative antibiotic prophylaxis to prevent surgical-site infections following primary total joint arthroplasty
    StudyCountryNo. of patients/
total jointsMean follow-up, yrMean age, yr% maleIntervention groupControl group
    Heydemann et al.,20 1986United States211/2111Age range: 23-88(mean NR)NREight 1-g IV boluses of nafcillin or cefazolin every 6 h until 48 h postoperatively (n = 108)No postoperative treatment 
(n = 103)
    Kanellakopoulou et al.,21 2009Greece616/61626923For all 3 study centres, antibiotic prophylaxis continued postoperatively for 4-6 d (antibiotic, dose, frequency and duration of physician's choosing; specifics NR) (n = 338)No postoperative treatment 
(n = 278)
    Ritter et al.,22 1989United States196/19616637Three 0.75-g IV boluses of cefuroxime every 8 h postoperatively for 24 h (n = 98)No postoperative treatment 
(n = 98)
    Wymenga et al.,23 1991Netherlands2892/3013169210.75-g IV cefuroxime 8 h and 16 h postoperatively (n = 1511 joints)No postoperative treatment 
(n = 1502 joints)

    Note: IV = intravenous, NR = not reported.

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      Table 2: Grading of Recommendations Assessment, Development and Evaluation (GRADE) summary of findings
      OutcomeNo. of participants (studies); length of follow-upQuality of evidence (GRADE)Anticipated effects
      Incidence of surgical-site infections4036 (4 trials); follow-up ≤ 2 yrVery low (owing to risk of bias, imprecision and inconsistency)The pooled absolute risk difference for surgical-site infections between postoperative antibiotic prophylaxis and placebo or no treatment was 0.01 (95% CI 0.00 to 0.02)

      Note: CI = confidence interval.

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      17 Jul 2015
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      Postoperative antibiotic prophylaxis in total hip and knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials
      Patrick Thornley, Nathan Evaniew, Michael Riediger, Mitchell Winemaker, Mohit Bhandari, Michelle Ghert
      Jul 2015, 3 (3) E338-E343; DOI: 10.9778/cmajo.20150012

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      Postoperative antibiotic prophylaxis in total hip and knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials
      Patrick Thornley, Nathan Evaniew, Michael Riediger, Mitchell Winemaker, Mohit Bhandari, Michelle Ghert
      Jul 2015, 3 (3) E338-E343; DOI: 10.9778/cmajo.20150012
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