Prevention of bone and joint infections.

The importance of preventing infections in bone and joint surgery is clear because of the devastating clinical and economic consequences. Prophylactic antibiotics have reduced the incidence of wound infection in surgery of noncompound hip fractures. Five studies of antibiotic prophylaxis in total hip replacement have concluded that prophylaxis has reduced the frequency of deep wound infection after surgery. The use of operating rooms supplied with ultra-clean air was also associated with a reduction in infection after insertion of a prosthetic joint. These studies suggest that ultra-clean air and antibiotic prophylaxis have independent and cumulative effects in preventing joint infection following surgery. Foci of infection elsewhere in the body can seed a prosthetic joint and, therefore, must be treated vigorously. However, there are no convincing data as to the potential risk to the prosthetic joint of procedures such as dental work or gastrointestinal or genitourinary tract manipulation. Currently, antibiotic prophylaxis for all patients with prosthetic joints about to undergo such procedures cannot be recommended.