Study designs of evaluations included in the review
Randomised controlled trials (RCTs).
Specific interventions included in the review
Antimicrobial prophylaxis versus no antimicrobial prophylaxis or placebo administered at the time of THR surgery. Included antimicrobials were cefonicid, cefoperazone, ceforanide, cefotaxime, cefoxitin, cefuroxime, cephalothin, cefamandole, cephazolin, cephradine, cloxacillin, gentamicin, lincomicin, teicoplanin and ticarcillin/clavulanic acid. The type of operating theatre (conventional/ultraclean) was also recorded with the intervention.
Participants included in the review
Patients undergoing an elective THR (either primary THR (replacement of the femoral head and the acetabulum) or revision THR (replacement of the acetabular or femoral components, or both, following the failure of a primary THR) regardless of protheses used. Patients in whom the principal diagnosis was infection of the hip were excluded from the review. Trials examining antimicrobial prophylaxis in both THR and TKR patients were included, with the results for THR analysed separately where possible.
Outcomes assessed in the review
Primary outcome measure was wound infection, either:
1. Major deep wound infection, a deep surgical wound infection (SWI) occurring at the incision site within one year and involving tissues or spaces at or beneath the fascial layer.
2. Minor superficial wound infection, an infection occurring at the incision site within 30 days after surgery, involving the skin, subcutaneous tissue, or muscle located above the fascial layer. Late prosthetic infections (up to one year following surgery) were also recorded.
Secondary outcome measures were: mortality related to infection; systemic infection (e.g. septicaemia); remote infection (e.g. urinary tract and respiratory tract infections); adverse effects; and resource use outcomes (e.g. length of hospital stay, re- operation, postoperative antibiotic therapy).
How were decisions on the relevance of primary studies made?
Two reviewers independently assessed the studies for inclusion. Discrepancies were resolved through discussion.