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Antibiotic and thromboembolic prophylaxis in total hip and knee arthroplasty in Scotland

Venous thromboembolism and wound infection are serious complications of lower limb arthroplasty. The incidence of these complications in Scotland ranges between 1% and 2%, with considerable regional variation. The Scottish Intercollegiate Guidelines Network (SIGN) was set up to develop evidence-based clinical guidelines for the NHS in Scotland. A questionnaire survey of orthopaedic consultants in Scotland was carried out to audit the regional preferences in both antibiotic and thromboembolic prophylaxis and to compare their conformity with the SIGN guidelines and published literature. The study revealed that despite SIGN guidelines and overwhelming clinical evidence, there is no consensus between orthopaedic surgeons in choice of prophylaxis. The majority of the respondents used a three-dose antibiotic regime (66.6%)and low molecular weight heparin for thromboprophylaxis (46.6%). Only 22.7% preferred a combinationof aspirin alongwith mechanicalcompression. The current practice is not supported by published guidelines or available clinical evidence, nor is it cost-effective. Further efforts are required to develop an acceptable national protocol


A Pillai

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