Single Antibiotic Dose Noninferior After Hip Arthroplasty

A single preoperative dose of prophylactic antibiotics was noninferior to multiple perioperative doses for preventing periprosthetic joint infection (PJI) after primary total hip arthroplasty (THA), according to a comparative effectiveness study published in JAMA Network Open.

Investigators used a target trial emulation to analyze nationwide Danish registry and microbiology data from 76,126 adults who underwent primary THA for osteoarthritis from 2010 through 2020. Of these patients, 6,409 received a single preoperative antibiotic dose and 69,717 received multiple prophylactic doses, defined as at least 1 additional dose within 24 hours after surgery. Follow-up extended to 1 year.

The primary outcome was PJI within 90 days. It occurred in 63 patients (0.98%) in the single-dose group and 656 patients (0.94%) in the multiple-dose group. After stabilized inverse probability of treatment weighting, the odds ratio was 0.97 (95% CI, 0.73-1.29), meeting the prespecified noninferiority criterion of an upper 95% CI below 1.40. The adjusted absolute risk difference was −0.03% (95% CI, −0.28% to 0.23%).

No statistically significant differences were observed across secondary outcomes, including likely PJI, revision for any cause, hospital-treated infection, community antibiotic use, all-cause mortality, and PJI within 365 days. Sensitivity analyses for PJI at 90 and 365 days were consistent across unadjusted, weighted, and propensity score–matched analyses.

The authors cautioned that residual confounding could not be excluded because prophylaxis may have been influenced by departmental guidance, surgeon judgment, and unmeasured patient factors. Exact timing and route of antibiotic administration were unavailable, and variation within the multiple-dose group may have reduced contrasts between regimens. They concluded that the findings support efforts to limit perioperative antibiotic exposure but require confirmation in randomized clinical trials.

Source: Abedi AA, Anneberg M, Pedersen AB, et al. Single- vs multiple-dose antibiotic prophylaxis for total hip arthroplasty. JAMA Netw Open. 2026;9(9):e2634586. doi:10.1001/jamanetworkopen.2026.34586