The use of antibiotic prophylaxis in hip arthroscopy is under-reported and lacks evidence-based guidelines: a systematic review and survey

Importance Hip arthroscopy is an increasingly common orthopaedic procedure with postoperative infection rates<5%. With the growing challenge of antibiotic resistance and rising healthcare costs, it is important to establish whether antibiotic prophylaxis is routinely used in hip arthroscopy, and whether it is necessary. Objective The objectives of this review were to (1) report current practice patterns with regard to antibiotic prophylaxis for hip arthroscopy and (2) present the available evidence regarding the use of antibiotic prophylaxis in hip arthroscopy. Evidence review The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed in the execution and reporting of this study. The databases MEDLINE, EMBASE and PubMed were searched and screened in duplicate. Data regarding patient demographics, surgical indications, surgical techniques, use of antibiotic prophylaxis and adverse events were collected. Study quality was assessed in duplicate using Methodological Index for Non-Randomised Studies criteria. A survey was distributed to high-volume hip arthroscopists to gauge their practice patterns. Data were analysed and presented using descriptive statistics. Findings Nine studies of primarily level IV evidence (78%) and of fair quality were included. Overall, 592 patients (652 hips; 56.2% male) were included in the review, with a mean age of 40.6 years. Notably, 1069 otherwise eligible studies were excluded from this review because they did not report on their use (or lack thereof) of prophylactic antibiotics. Overall, 390 patients received routine antibiotic prophylaxis, 160 patients did not and 42 patients received prophylaxis only if an implant was used. Only three infections were reported among 652 operations, with all infections from studies that routinely used antibiotic prophylaxis. The survey had a 60% response rate (21/35), and revealed that 81% of respondents routinely provide prophylactic antibiotics, most commonly preoperative intravenous cefazolin (66.7%). The most common postoperative antibiotic was cephalexin. Conclusions and relevance Antibiotic prophlyaxis use in hip arthroscopy is very under-reported. Routine prophylaxis was the most common practice pattern in both the literature and the survey. Overall, postoperative infection rates are extremely low. Future studies are required to prospectively assess the role of antibiotic prophylaxis in hip arthroscopy. Level of evidence Level IV, systematic review of level III and IV studies