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
CRISTALJAMA 2022
Effect of Aspirin vs Enoxaparin on Symptomatic Venous Thromboembolism in Patients Undergoing Hip or Knee Arthroplasty: The CRISTAL Randomized Trial.
Aspirin failed to show non-inferiority and was associated with a significantly higher rate of symptomatic VTE than enoxaparin, mainly driven by below-knee DVT. There was no significant difference in death or major bleeding.
Randomised trialPreventionHip arthroplasty
VITAL fracture analysisThe New England journal of medicine 2022
Supplemental Vitamin D and Incident Fractures in Midlife and Older Adults
Vitamin D3 did not significantly reduce total, non-vertebral or hip fractures compared with placebo.
Randomised trialPreventionRheumatology & metabolic bone
WHISTJAMA 2020
Effect of Incisional Negative Pressure Wound Therapy vs Standard Wound Dressing on Deep Surgical Site Infection After Surgery for Lower Limb Fractures Associated With Major Trauma: The WHIST Randomized Clinical Trial.
There was no significant difference in deep surgical site infection at 30 days between incisional negative pressure therapy and standard dressings.
Randomised trialPreventionLower limb trauma
EPCAT IIIThe New England journal of medicine 2018
Aspirin or Rivaroxaban for VTE Prophylaxis after Hip or Knee Arthroplasty.
Aspirin was non-inferior to rivaroxaban for symptomatic VTE, with low event rates in both groups. There was no significant difference in major or clinically relevant bleeding.
Randomised trialPreventionHip arthroplasty
SCOOPLancet (London, England) 2018
Screening in the community to reduce fractures in older women (SCOOP): a randomised controlled trial
Screening increased uptake of osteoporosis medication but did not significantly reduce the primary outcome of all osteoporosis-related fractures; hip fractures, a prespecified secondary outcome, were reduced.
Randomised trialPreventionRheumatology & metabolic bone
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
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
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
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
IMPACT PONV (Apfel)The New England journal of medicine 2004
A factorial trial of six interventions for the prevention of postoperative nausea and vomiting.
Ondansetron, dexamethasone and droperidol each reduced PONV risk by roughly a quarter, and propofol and avoiding nitrous oxide also helped; the effects were independent and additive, so combining interventions reduced risk further.
Randomised trialPreventionPost-op care & complications
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
Geriatric consultation for delirium (Marcantonio)Journal of the American Geriatrics Society 2001
Reducing delirium after hip fracture: a randomized trial.
Proactive geriatric consultation significantly reduced the incidence of delirium (about one third vs one half) and reduced severe delirium by a greater margin.
Randomised trialPreventionPost-op care & complications
Chapuy calcium and vitamin DThe New England journal of medicine 1992
Vitamin D3 and calcium to prevent hip fractures in elderly women
Supplementation significantly reduced hip fractures and other non-vertebral fractures, with correction of secondary hyperparathyroidism.
Randomised trialPreventionRheumatology & metabolic bone
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
Lewinnek safe zoneThe Journal of bone and joint surgery. American volume 1978
Dislocations after total hip-replacement arthroplasties.
Cups within about 15 degrees (plus or minus 10) of anteversion and 40 degrees (plus or minus 10) of inclination dislocated less often than those outside this 'safe zone'; increased anteversion was linked to anterior dislocation, and risk was highest early after surgery and in previously operated hips.
Cohort studyPreventionHip arthroplasty