We retrospectively analyzed 490 patients who underwent aseptic revision total hip replacement (R-THA) and found no difference in culture results between antibiotic prophylaxis (AP) administered before incision or after tissue biopsy. Although not significant, infection was twice as likely when AP was given after incision. Other literature also supports the benefit of pre-incisional AP. We therefore believe AP should be given pre-incision to prevent unnecessarily exposing patients to infections.