Analysis of therapeutic efficacy, cost, and safety of gentamicin lavage solution in orthopaedic surgery prophylaxis.

Prophylactic antibiotic irrigation solutions are used quite commonly during total joint arthroplasty; however, scientific data regarding their efficacy are inconclusive. In a retrospective review of 100 total joint replacements (53 total hips and 47 total knees) that substituted gentamicin for kanamycin as an intraoperative irrigant, no apparent variation from the incidence of infection reported to the literature occurred, and no evidence of drug-induced side effects presented. Antibiotic irrigation solutions are probably noncontributory to infection prevention when used concomitantly with systemic prophylaxis. Most orthopaedic surgeons will continue to utilize them, however, owing to the catastrophic nature of a deep infection and the prevailing medicolegal atmosphere. Gentamicin is therefore a cost-effective antibiotic for intraoperative lavage--it has a sound microbiologic and safety profile, despite its lack of proven efficacy.