Results showed extended oral antibiotic prophylaxis after aseptic revision total hip arthroplasty was not associated with a decreased risk of infection, despite a statistically insignificant trend toward a protective effect.
Brandon R. Bukowski, MD, and colleagues at Mayo Clinic, Rochester retrospectively reviewed data on 1,107 aseptic revision THAs performed between Jan. 1, 2014, and July 1, 2019, with a mean follow-up of 4 years. The researchers used an inverse probability of treatment weighting model to compare outcomes between 267 patients who received extended oral antibiotic (EOA) prophylaxis at least 24 hours after surgery and 637 patients who received no EOA prophylaxis.
According to the study, the most prescribed antibiotic regimen was 500 mg of cephalexin by mouth four times daily, with a mean duration of EOA prophylaxis of 10 days. The most common indications for revision were aseptic loosening (in 24% of patients), instability or dislocation (in 18% of patients), and polyethylene wear or osteolysis (in 17% of patients). Outcome measures included probability of any infection, periprosthetic joint infection (PJI), re-revision and reoperation.
Bukowski and colleagues found no statistically significant differences in risk of PJI or any infection between groups at 90 days, 1 year or at final follow-up. Overall, the cumulative probability of PJI after aseptic revision THA was 1.7% at 90 days, 2.1% at 1 year and 2.8% at 5 years. Similarly, the cumulative probability of any infection after aseptic revision THA was 2.3% at 90 days, 2.7% at 1 year and 3.5% at 5 years.
“EOA with a mean duration of therapy of 10 days after surgery was not associated with a statistical decreased risk of any infection, PJI, re-revision for infection, or reoperation for infection,” the researchers wrote in the study. “However, there was a trend toward a protective effect of EOA at all time points that was strongest at final follow-up. Thus, the results of this study suggest that additional prospective randomized trials evaluating the relationship between EOA and infection-related outcomes would be worthwhile to pursue.”