In a prospective comparative clinical efficacy and safety study, 58 patients undergoing total hip or knee arthroplasty were randomly allocated to two groups; one received 29 cefamandole intravenously before operation and then 1 g every 6 h parenterally for 3 days and the other received 29 cloxacillin i.v every 8 h for 1 day and 29 dicloxacillin perorally every 8 h for 2 days Concentrations of cefamandole and cloxacillin were measured in the serum of all patients and in the synovial fluid of 28 patients The serum C-reactive protein (CRP) level was measured in 16 randomly allocated patients preoperatively and daily for 8 days In serum the concentrations of cefamandole and cloxacillin were high The great variation in cloxacillin concentration can be due in part to its strong affinity for blood proteins Cefamandole entered the synovial fluid of the knee joint at high concentrations in 5-15 min; similar concentrations of cloxacillin were measured after 16-30 min Thus, cefamandole seems to be more recommendable as antibiotic prophylaxis in total hip and knee replacements The CRP level decreased to below 60 mg/l in all 16 patients on the 6th postoperative day.
Parenteral antibiotic prophylaxis or bone cement with antibiotic is used in total hip or knee replacements Due to this prophylaxis, early infections in hip arthroplasties have decreased from 5 8 % to 0 5 %-2 % l 8 l.
The beginning time and length of antibiotic prophylaxis in arthroplasty vary greatly Schurmann et