Abstract

One hundred seventy-four elective operations for hip and knee prostheses were undertaken in conditions of ultra-clean air and antibiotic prophylaxis (with cefuroxime), as the recent Medical Research Council multicenter study suggested that this combination was most likely to give the lowest infection rate. No acute infections of a prosthesis occurred (early infection rate less than 0.6%), while the rate was 2.9% for purulent wound infection which did not involve the prostheses. Late infections, at 3 months and 1 year, occurred in only 2 patients (a rate of 1.1%), resulting from probable bacteremia, which necessitated removal of the prosthesis. These results are considered satisfactory, especially in a compromised patient population of mean age 71 years. Such low infection rates underscore the need to continue the combined use of ultraclean air and antibiotics for hip and knee prosthetic surgery, or to introduce them where absent, to prevent the occurrence of airborne staphylococcal infection; either technique alone was shown to be less effective in the Medical Research Council multicenter study.