Antibiotic prophylaxis for wound infections in total joint arthroplasty

Abstract

We reviewed systematically the published evidence on the effectiveness of antibiotic prophylaxis for the reduction of wound infection in patients undergoing total hip and total knee replacement. Publications were identified using the Cochrane Library, MEDLINE, EMBASE and CINAHL databases. We also contacted authors to identify unpublished trials. We included randomised controlled trials which compared any prophylaxis with none, the administration of systemic antibiotics with that of those in cement, cephalosporins with glycopeptides, cephalosporins with penicillin-derivatives, and second-generation with first-generation cephalosporins. A total of 26 studies (11 343 participants) met the inclusion criteria. Methodological quality was variable. In a meta-analysis of seven studies (3065 participants) antibiotic prophylaxis reduced the absolute risk of wound infection by 8% and the relative risk by 81% compared with no prophylaxis (p < 0.00001). No other comparison showed a significant difference in clinical effect. Antibiotic prophylaxis should be routine in joint replacement but the choice of agent should be made on the basis of cost and local availability.

Bone tissue engineering: A review in bone biomimetics and drug delivery strategies

“…Infection (sepsis) and subsequent patient morbidity and huge associated costs has been reported to occur as frequently as 5% in the case of total joint replacement surgeries. [302][303][304] Naturally, prophylactic administration of antibiotics has been shown to reduce the risk of sepsis by 81%. 303 However, conventional systemic delivery of antibiotics has major drawbacks such as systemic toxicity, renal complications, liver complications, poor penetration into necrotic tissue, and the need for hospitalization.…”

“…[302][303][304] Naturally, prophylactic administration of antibiotics has been shown to reduce the risk of sepsis by 81%. 303 However, conventional systemic delivery of antibiotics has major drawbacks such as systemic toxicity, renal complications, liver complications, poor penetration into necrotic tissue, and the need for hospitalization. 305 In an effort to prevent these adverse systemic side effects, researchers are aggressively pursuing strategies to deliver antibiotics locally to the site of injury/surgery.…”

What Are the Risk Factors for Infection in Hemiarthroplasties and Total Hip Arthroplasties?

“…Moreover, several of those studies are not primarily focused on infection, although they contain information on infected patients [11,13,17,18,24,36,40,45,46]. Finally, the level of evidence in many of them is low; we have found seven case series (Level of Evidence IV) [3,6,13,16,17,21,40,46] and many nonsystematic reviews (Level of Evidence V) [1,18,23,25,28,34,38,45] and expert opinions (Level of Evidence V) [2,4,30]. We believe it important to learn and identify these risk factors in the individual patient for to check for and minimize risk factors or, when not possible to consider specific prophylactic measures.…”

“…The data on whether diabetes, obesity, rheumatoid arthritis, or immunosuppressants increase the risk of infection are contradictory [6,13,17,20,24,28,33,35,37,40]. Surgical time [22,33,35,38,44] and inadequate antibiotic prophylaxis [1,41,44] are accepted major risk factors among intraoperative variables. Dislocation [36] and hematoma [37] are accepted risk factors, whereas the influence of prolonged drainage is debated [15,32,36,37].…”

CORR Insights®: What is the Intraarticular Concentration of Tobramycin Using Low-dose Tobramycin Bone Cement in TKA: An In Vivo Analysis?

“…One strategy to reduce the occurrence of periprosthtetic infections is to use antibiotic-laden bone cement (ALBC) at the time of primary TKA. This strategy remains controversial, as data from national registries, randomized clinical trials and meta-analyses suggest a protective effect of ALBC against infection when used in hips, but a variable effect in knees [1,2,4,5,9,11]. It is not clear whether the inconsistent efficacy in TKA is related to the duration and quantity of locally elevated antibiotic levels in TKA as compared to that seen after THA.…”