Can a single dose of antibiotics provide sufficient protection against infection after hip replacement surgery? A new study from Denmark suggests that a single preoperative dose of antibiotic prophylaxis may be as effective as multiple doses in preventing periprosthetic joint infection (PJI) following total hip arthroplasty (THA).
Published in JAMA Network Open, the study found that patients receiving a single antibiotic dose before surgery had comparable infection outcomes to those receiving multiple doses within 24 hours after surgery. The findings suggest that reducing antibiotic exposure around surgery could help limit unnecessary antibiotic use without compromising infection prevention.
Study examines single-dose and multiple-dose antibiotic regimens
Researchers led by Armita Armina Abedi from the Department of Orthopedic Surgery and Traumatology, Copenhagen University Hospital, Bispebjerg, Denmark, compared infection outcomes among patients undergoing primary total hip arthroplasty for osteoarthritis.
Although doctors routinely administer antibiotic prophylaxis during joint replacement surgery to prevent infections, the optimal duration of treatment remains debated. Therefore, the researchers investigated whether a single preoperative dose could offer protection comparable to that of multiple postoperative doses.
The population-based comparative effectiveness study used Danish national registry and microbiology data to emulate a target clinical trial. It included 76,126 patients who underwent primary hip replacement surgery between January 2010 and December 2020. Researchers followed the patients for up to one year.
Of these patients, 6,409 received a single preoperative antibiotic dose, while 69,717 received multiple prophylactic doses within 24 hours after surgery. The primary outcome was periprosthetic joint infection within 90 days, identified through microbiological confirmation or clinical diagnosis during revision surgery.
Single-dose antibiotics show comparable infection outcomes
The analysis found that infection rates were similar between the two groups.
Key findings included:
- 90-day infection rates: PJI occurred in 0.98% of patients receiving a single antibiotic dose, compared with 0.94% among those receiving multiple doses.
- Noninferiority: The weighted analysis reported an odds ratio of 0.97 (95% confidence interval: 0.73–1.29), meeting the study’s prespecified noninferiority criterion.
- Consistent results: The findings remained similar when researchers assessed infections at 90 and 365 days.
- Additional analyses: Results were also consistent across secondary outcomes and different analytical approaches, including propensity score matching.
The study population had a mean age of 68.8 years, and women accounted for 55.9% of participants.
Study highlights limitations
Despite the encouraging findings, the researchers acknowledged several limitations. Since the study was observational, they could not completely rule out residual confounding, including differences in patients’ health conditions and other factors that may have influenced doctors’ antibiotic choices.
Additionally, variations in the multiple-dose regimens and incomplete information about the exact timing and route of antibiotic administration may have affected comparisons between the groups.
The researchers also cautioned that meeting the statistical noninferiority criterion does not rule out modest differences in absolute infection risk, particularly across populations with different baseline infection rates.
Randomised trials needed to confirm findings
Overall, the study found that a single preoperative antibiotic dose was noninferior to multiple-dose prophylaxis in preventing periprosthetic joint infections after primary total hip arthroplasty.
The findings support the possibility of reducing unnecessary antibiotic exposure during hip replacement surgery while maintaining comparable infection prevention. However, the researchers emphasised that randomised clinical trials are necessary to confirm these results and establish whether single-dose prophylaxis can be widely adopted in clinical practice.
As reported by Medical Dialogues, the findings could help inform future approaches to antibiotic use and infection prevention in joint replacement surgery.