Long-term study of the peroperative infection rate in 1007 total hip replacements using prophylactic cefamandole and other precautions.

Of 1824 primary total hip replacements performed between April 1, 1979, and December 31, 1983, 1007 were reviewed at regular interval and provided sufficiently complete data with special emphasis on pre- and postoperative bacteriological examination and pre- and postoperative determination of the erythrocyte sedimentation rate. All patients with known superficial and deep infections were included. In all cases 2 g of cefamandole q.i.d. were administered within a 24-h period starting with the induction of the anesthesia. All procedures were performed in operating rooms equipped with a vertical laminar air flow. Other precautions included the use of Charnley gowns with a body exhaust system, special draping of the patient, and preoperative culture of the urine. As of June, 1981, gentamicin-loaded polymethylmetacrylate was used routinely. When positive cultures were found in the swabs taken from the tissues during the surgical procedure, appropriate antibiotics were started if the patient was still hospitalized. Follow-up showed two deep (0.2%) and four superficial infections (0.4%). Host factors may play a more important role than suspected, since one patient with a deep infection suffered from severe rheumatoid arthritis and the other from diabetes. Both these patients underwent bilateral hip replacement, the second intervention following the first within 5 weeks. In these two patients the deep infection became apparent 5 and 9 months after the second procedure. Only one of these patients developed a sinus (Staphylococcus aureus).(ABSTRACT TRUNCATED AT 250 WORDS)