Comparative effectiveness of antibiotic prophylaxis for preventing serious adverse events after primary total hip arthroplasty: a systematic review and network meta-analysis of randomized trials
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: ...
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| Language: | English |
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Medical Journals Sweden
2025-08-01
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| Series: | Acta Orthopaedica |
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| Online Access: | https://actaorthop.org/actao/article/view/44482 |
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| author | Armita A Abedi Jacob M Svensson Alma B Pedersen Claus Varnum Sabrina M Nielsen Jens H Laigaard Robin Christensen Søren Overgaard |
| author_facet | Armita A Abedi Jacob M Svensson Alma B Pedersen Claus Varnum Sabrina M Nielsen Jens H Laigaard Robin Christensen Søren Overgaard |
| author_sort | Armita A Abedi |
| collection | DOAJ |
| description |
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.
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| format | Article |
| id | doaj-art-bba2e1c3edaf46008bc16f267e9baf01 |
| institution | Kabale University |
| issn | 1745-3674 1745-3682 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Medical Journals Sweden |
| record_format | Article |
| series | Acta Orthopaedica |
| spelling | doaj-art-bba2e1c3edaf46008bc16f267e9baf012025-08-20T04:03:26ZengMedical Journals SwedenActa Orthopaedica1745-36741745-36822025-08-019610.2340/17453674.2025.44482Comparative effectiveness of antibiotic prophylaxis for preventing serious adverse events after primary total hip arthroplasty: a systematic review and network meta-analysis of randomized trialsArmita A Abedi0Jacob M Svensson1https://orcid.org/0000-0002-4896-1519Alma B Pedersen2https://orcid.org/0000-0002-3288-9401Claus Varnum3https://orcid.org/0000-0002-0625-5691Sabrina M Nielsen4Jens H Laigaard5Robin Christensen6https://orcid.org/0000-0002-6600-0631Søren Overgaard7https://orcid.org/0000-0001-6829-4787Department of Orthopaedic Surgery and Traumatology, Copenhagen University Hospital, Bispebjerg; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen; Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, DenmarkDepartment of Orthopaedic Surgery and Traumatology, Copenhagen University Hospital, Bispebjerg; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, DenmarkDepartment of Clinical Epidemiology, Aarhus University Hospital, Aarhus; Department of Clinical Medicine, Aarhus University, Aarhus, DenmarkDepartment of Orthopaedic Surgery, Lillebaelt Hospital, Vejle; Department of Regional Health Research, University of Southern Denmark, Odense, DenmarkSection for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, DenmarkDepartment of Orthopaedic Surgery and Traumatology, Copenhagen University Hospital, Bispebjerg; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, DenmarkSection for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, DenmarkDepartment of Orthopaedic Surgery and Traumatology, Copenhagen University Hospital, Bispebjerg; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark 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. https://actaorthop.org/actao/article/view/44482Antibiotic ProphylaxisPreventionProsthetic Joint InfectionSerious Adverse EventsCemented Total Hip Arthroplasty |
| spellingShingle | Armita A Abedi Jacob M Svensson Alma B Pedersen Claus Varnum Sabrina M Nielsen Jens H Laigaard Robin Christensen Søren Overgaard Comparative effectiveness of antibiotic prophylaxis for preventing serious adverse events after primary total hip arthroplasty: a systematic review and network meta-analysis of randomized trials Acta Orthopaedica Antibiotic Prophylaxis Prevention Prosthetic Joint Infection Serious Adverse Events Cemented Total Hip Arthroplasty |
| title | Comparative effectiveness of antibiotic prophylaxis for preventing serious adverse events after primary total hip arthroplasty: a systematic review and network meta-analysis of randomized trials |
| title_full | Comparative effectiveness of antibiotic prophylaxis for preventing serious adverse events after primary total hip arthroplasty: a systematic review and network meta-analysis of randomized trials |
| title_fullStr | Comparative effectiveness of antibiotic prophylaxis for preventing serious adverse events after primary total hip arthroplasty: a systematic review and network meta-analysis of randomized trials |
| title_full_unstemmed | Comparative effectiveness of antibiotic prophylaxis for preventing serious adverse events after primary total hip arthroplasty: a systematic review and network meta-analysis of randomized trials |
| title_short | Comparative effectiveness of antibiotic prophylaxis for preventing serious adverse events after primary total hip arthroplasty: a systematic review and network meta-analysis of randomized trials |
| title_sort | comparative effectiveness of antibiotic prophylaxis for preventing serious adverse events after primary total hip arthroplasty a systematic review and network meta analysis of randomized trials |
| topic | Antibiotic Prophylaxis Prevention Prosthetic Joint Infection Serious Adverse Events Cemented Total Hip Arthroplasty |
| url | https://actaorthop.org/actao/article/view/44482 |
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