Prophylaxis with systemic antibiotics versus gentamicin bone cement in total hip arthroplasty. A five-year survey of 1688 hips.

In Sweden in 1976, nine orthopedic departments organized a prospective, randomized, and controlled study in which the prophylactic effect of systemic antibiotics (SA) was compared to gentamicin bone cement (GBC) in 1688 consecutive total hip arthroplasties (THAs). After a follow-up period of one to two years, there was a statistically significant difference in the infection rate between the two groups in favor of the gentamicin cement. After five years or more, the difference was unaltered. Altogether, 16 deep infections had occurred in the SA group (1.9%) and seven (0.8%) in the GBC group. Roentgenographically, aseptic loosening had occurred in 29% and 24% of the hips in the SA and GBC groups, respectively, which suggests that admixture of the antibiotic did not weaken the cement. The results of this five-year review clearly showed the prophylactic value of gentamicin cement against deep infection after THA but did not support the hypothesis that this effect was prolonged over one year.