WHiTE 8 COPALLancet (London, England) 2023
High-dose dual-antibiotic loaded cement for hip hemiarthroplasty in the UK (WHiTE 8): a randomised controlled trial.
Deep surgical site infection did not differ significantly between high-dose dual-antibiotic and standard single-antibiotic cement.
Randomised trialPreventionOperative technique & equipment
NZ registry laminar flow and space suitsThe Journal of bone and joint surgery. British volume 2011
Does the use of laminar flow and space suits reduce early deep infection after total hip and knee replacement?: the ten-year results of the New Zealand Joint Registry.
Laminar flow and space suits were not associated with lower early revision for deep infection; early infection revision was significantly higher with their use in both hip and knee replacement, independent of age, diagnosis and operating time.
Registry studyPreventionOperative technique & equipment
Sutures vs staples meta-analysisBMJ (Clinical research ed.) 2010
Sutures versus staples for skin closure in orthopaedic surgery: meta-analysis.
Staples were associated with a significantly higher risk of superficial wound infection than sutures, particularly after hip surgery.
Systematic review / meta-analysisPreventionOperative technique & equipment
Chlorhexidine-alcohol vs povidone-iodineThe New England journal of medicine 2010
Chlorhexidine-Alcohol versus Povidone-Iodine for Surgical-Site Antisepsis.
Overall surgical site infection was significantly lower with chlorhexidine-alcohol (about 10% vs 16%), driven by fewer superficial and deep incisional infections; organ-space infection did not differ.
Randomised trialPreventionOperative technique & equipment
Bode nasal decolonisationThe New England journal of medicine 2010
Preventing surgical-site infections in nasal carriers of Staphylococcus aureus.
Decolonisation more than halved hospital-acquired S. aureus infection, with the largest effect on deep surgical site infection; mortality did not differ.
Randomised trialPreventionOperative technique & equipment
Norwegian registry antibiotic cementActa orthopaedica Scandinavica 2003
Antibiotic prophylaxis in total hip arthroplasty: effects of antibiotic prophylaxis systemically and in bone cement on the revision rate of 22,170 primary hip replacements followed 0-14 years in the Norwegian Arthroplasty Register.
Combined systemic and cement antibiotic prophylaxis carried the lowest revision risk; systemic prophylaxis alone was associated with higher revision for any cause, aseptic loosening and infection. Within the combined regime, four systemic doses on the day of surgery performed best.
Registry studyPreventionOperative technique & equipment
Lidwell ultraclean airBritish medical journal (Clinical research ed.) 1982
Effect of ultraclean air in operating rooms on deep sepsis in the joint after total hip or knee replacement: a randomised study.
Deep joint sepsis was roughly halved with ultraclean air and reduced further when whole-body exhaust suits were also worn; prophylactic antibiotic use was associated with lower sepsis, though this was not tested in a controlled way.
Randomised trialPreventionOperative technique & equipment