Efficacy of a single dose of cefazolin as a prophylactic antibiotic in primary arthroplasty

We analyzed the wound infection rate of 1,367 primary total hip and knee arthroplasties performed between 1991 and 1999. Two hundred and fifteen arthroplasties were performed with 3 doses (3 × 750 mg) of cefuroxime, and 1,152 arthroplasties were performed with a single preoperative dose (1 × 1 g) of cefazolin as antimicrobial prophylaxis. All wound infections that occurred within 2 years of the index surgery were analyzed. The deep wound infection rate of total hip arthroplasty was 1.1% (95% confidence interval [CI], 0%–3.3%) in the cefuroxime group and 1.1% (95% CI, 0%–2.2%) in the cefazolin group (Fisher’s exact test, P = 1.0). The deep wound infection rate of total knee arthroplasty in the cefuroxime group (1.6%; 95% CI, 0%–3.8%) was not significantly different from the cefazolin group (1.0%; 95% CI, 0.3%–1.7%) (Fisher’s exact test, P = .63). We concluded that a single dose (1 g) of cefazolin given at anesthetic induction offered similar protection to 3 doses (3 × 750 mg) of cefuroxime in preventing infection in primary total joint arthroplasty.