Aims: Evaluation of postoperative infections in T.H.R. and T.K.R., after randomized prophylactic use of Fusidic acid, Vancomycin and Cefuroxime and assessment of their side effects.

Methods: From December 2000 to April 2002, 128 patients were operated on T.H.R. and T.K.R. in Orthopaedic Department of University of Patras (64 for T.H.R. and 47 for T.K.R.). Mean age was 66.5 years (range 45–90yrs.). The patients were categorized into three groups. In the first group was administrated Fusidic acid 500mg and Cefuroxime 1.5gr preoperatively and 2 doses of Fusidic acid 500mg postoperatively. The second group received Vancomycin 1gr and Cefuroxime 1.5gr preoperatively and 2 doses of Vancomycin 1gr postoperatively. The third group received Cefuroxime 1.5gr preoperatively and 2 doses of Cefuroxime 750mg postoperatively. Blood tests were systematically performed preoperatively, and the first and fifth postoperative day. Mean follow up was 8 months. Results: No deep wound infection was observed. Superficial infections developed 2 pt. (1.58%) of the first group, 2 pt. (1.58%) of the second group and 3 pt. (2.3%) of the third group. Temperature over 38.3° C attributed to another infection site was observed in 4 pt. of the first group, 2 pt. of the second group and 7 pt. of the third group, while temperature over 38.3° C with unknown origin was noted in 7,2,6 patients respectively. No side effect was recorded.

Conclusions: The proper use of antibiotic prophylaxis according to pharmakokinetic and pharmakodvnamic properties combined with sterile surgical techniques, prevents early deep wound infections in T.H.R. and T.K.R. The use of specific antistaphylococcal agents is of no benefit in antimicrobial prophylaxis for the above operations.

Between January 1990 and October 2000, 108 total hip arthroplasties using a cemented polished titanium stem and a cemented ultra-high molecular weight polyethylene (UHMWP) cup were performed at our hospital. Because during routine follow-up visits we noted instances of resorption of the calcar, we decided to assess whether this was a problem. We were able to assess 85 of the original 108 hips.

Calcar resorption was observed in 43 hips. The extent of calcar resorption varied from 1 mm to over 15 mm. In one patient a biopsy showed typical polyethylene granuloma.

Because there is a risk of long-term failure, we concluded that it is inadvisable to use a cemented polished titanium stem when UHMWP is one of the bearing surfaces.