Single-Dose Antibiotic Prophylaxis Noninferior to Multiple Doses in Total Hip Arthroplasty: JAMA
Denmark: Researchers have found in a new study that a single preoperative dose of antibiotic prophylaxis was noninferior to multiple-dose regimens for preventing periprosthetic joint infection (PJI) after total hip arthroplasty (THA). The findings suggest that reducing perioperative antibiotic exposure may help limit antibiotic overuse, although randomized clinical trials are needed for confirmation.
The study, published in JAMA Network Open by Armita Armina Abedi, Department of Orthopedic Surgery and Traumatology, Copenhagen University Hospital, Bispebjerg, Denmark, and colleagues, compared infection outcomes among patients undergoing primary THA for osteoarthritis.
Although antibiotic prophylaxis is routinely used around joint replacement surgery to reduce infection risk, the optimal duration of prophylaxis remains debated. The researchers assessed whether limiting treatment to a single dose before surgery could provide similar protection to regimens involving additional postoperative doses.
The population-based comparative effectiveness study used Danish national registry and microbiology data and emulated a target clinical trial. It included primary THA procedures performed across hospitals in Denmark between January 2010 and December 2020, with patients followed for up to one year.
The analysis involved 76,126 patients with osteoarthritis who underwent primary THA. Of these, 6,409 received a single preoperative antibiotic dose, while 69,717 received multiple prophylactic doses within 24 hours after surgery. The primary outcome was PJI occurring within 90 days, identified through microbiological confirmation or a clinical diagnosis recorded during revision surgery.
Key findings:
- PJI within 90 days occurred in 0.98% of patients receiving a single dose versus 0.94% receiving multiple doses.
- Weighted analysis produced an odds ratio of 0.97 (95% CI, 0.73–1.29), meeting the prespecified noninferiority criterion.
- Results remained consistent in analyses examining infection at 90 and 365 days.
- Findings were also similar across secondary outcomes and different analytical approaches, including propensity score matching.
- The study population had a mean age of 68.8 years, and 55.9% were women.
The researchers noted several limitations. As an observational study, residual confounding could not be completely excluded, including differences in frailty or other factors influencing clinicians' choice of antibiotic regimen. Variation within the multiple-dose group and incomplete information regarding exact antibiotic timing and administration route may also have reduced the distinction between treatment strategies.
The researchers further cautioned that noninferiority was established according to the prespecified odds-ratio margin, while modest increases in absolute infection risk could still be compatible with the findings depending on baseline PJI rates.
Overall, the study found that a single preoperative antibiotic dose was noninferior to multiple-dose prophylaxis for preventing PJI after primary THA. The findings support efforts to reduce unnecessary perioperative antibiotic exposure, although the authors emphasized that randomized clinical trials are needed to confirm the results.
Reference:
Abedi AA, Anneberg M, Pedersen AB, Varnum C, Christensen R, Overgaard S. Single- vs Multiple-Dose Antibiotic Prophylaxis for Total Hip Arthroplasty. JAMA Netw Open. 2026;9(9):e2634586. doi:10.1001/jamanetworkopen.2026.34586
