{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:10:06Z","timestamp":1785888606399,"version":"3.56.0"},"reference-count":40,"publisher":"BMJ","issue":"3","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2014,2,2]]},"published-print":{"date-parts":[[2014,3]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To synthesise the available evidence and estimate the comparative efficacy of control strategies to prevent total hip replacement (THR)-related surgical site infections (SSIs) using a mixed treatment comparison.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>Systematic review and mixed treatment comparison.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>Hospital and other healthcare settings.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Participants<\/jats:title>\n                  <jats:p>Patients undergoing THR.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Primary and secondary outcome measures<\/jats:title>\n                  <jats:p>The number of THR-related SSIs occurring following the surgical operation.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>12 studies involving 123\u2005788 THRs and 9 infection control strategies were identified. The strategy of \u2018systemic antibiotics+antibiotic-impregnated cement+conventional ventilation\u2019 significantly reduced the risk of THR-related SSI compared with the referent strategy (no systemic antibiotics+plain cement+conventional ventilation), OR 0.13 (95% credible interval (CrI) 0.03\u20130.35), and had the highest probability (47\u201364%) and highest median rank of being the most effective strategy. There was some evidence to suggest that \u2018systemic antibiotics+antibiotic-impregnated cement+laminar airflow\u2019 could potentially increase infection risk compared with \u2018systemic antibiotics+antibiotic-impregnated cement+conventional ventilation\u2019, 1.96 (95% CrI 0.52\u20135.37). There was no high-quality evidence that antibiotic-impregnated cement without systemic antibiotic prophylaxis was effective in reducing infection compared with plain cement with systemic antibiotics, 1.28 (95% CrI 0.38\u20133.38).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>We found no convincing evidence in favour of the use of laminar airflow over conventional ventilation for prevention of THR-related SSIs, yet laminar airflow is costly and widely used. Antibiotic-impregnated cement without systemic antibiotics may not be effective in reducing THR-related SSIs. The combination with the highest confidence for reducing SSIs was \u2018systemic antibiotics+antibiotic-impregnated cement+conventional ventilation\u2019. Our evidence synthesis underscores the need to review current guidelines based on the available evidence, and to conduct further high-quality double-blind randomised controlled trials to better inform the current clinical guidelines and practice for prevention of THR-related SSIs.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2013-003978","type":"journal-article","created":{"date-parts":[[2014,3,6]],"date-time":"2014-03-06T22:11:14Z","timestamp":1394143874000},"page":"e003978","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":33,"title":["Control strategies to prevent total hip replacement-related infections: a systematic review and mixed treatment comparison"],"prefix":"10.1136","volume":"4","author":[{"given":"Henry","family":"Zheng","sequence":"first","affiliation":[{"name":"Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian G","family":"Barnett","sequence":"additional","affiliation":[{"name":"Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katharina","family":"Merollini","sequence":"additional","affiliation":[{"name":"Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Sutton","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, University of Leicester, Leicester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Cooper","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, University of Leicester, Leicester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tony","family":"Berendt","sequence":"additional","affiliation":[{"name":"Oxford University Hospitals NHS Trust, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennie","family":"Wilson","sequence":"additional","affiliation":[{"name":"Institute of Practice, Interdisciplinary Research and Enterprise, University of Western London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Graves","sequence":"additional","affiliation":[{"name":"Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2014,3,6]]},"reference":[{"key":"2025101813283629000_4.3.e003978.1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.285.6334.10"},{"key":"2025101813283629000_4.3.e003978.2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.J.01251"},{"key":"2025101813283629000_4.3.e003978.3","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e31818b757d"},{"key":"2025101813283629000_4.3.e003978.4","first-page":"1","article-title":"Antimicrobial prophylaxis in total hip replacement: a systematic review","volume":"3","author":"Glenny","year":"1999","journal-title":"Health Technol Assess (Winchester, England)"},{"key":"2025101813283629000_4.3.e003978.5","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.G.00637"},{"key":"2025101813283629000_4.3.e003978.6","doi-asserted-by":"publisher","DOI":"10.1080\/17453670710015229"},{"key":"2025101813283629000_4.3.e003978.7","doi-asserted-by":"crossref","first-page":"1334","DOI":"10.3928\/0147-7447-20051101-13","article-title":"Reducing the risk of deep wound infection in primary joint arthroplasty with antibiotic bone cement","volume":"28","author":"Block","year":"2005","journal-title":"Orthopedics"},{"key":"2025101813283629000_4.3.e003978.8","unstructured":"Whitehead S Bending M Trueman P . 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