Is a Single Dose of Antibiotic Prophylaxis Sufficient to Prevent Infections in Total Joint Arthroplasty?

INTRODUCTION: Prosthetic infection is a serious complication that can develop after knee and hip arthroplasty and remains a common reason for revision surgery. Guidelines recommend various measures to prevent infection, howewer some professional associations argue that there is insufficient evidence for single-dose antibiotic prophylaxis. Our study compares the outcomes of patients receiving short- and long-term antibiotic prophylaxis in arthroplasty surgery.
METHODS: In this retrospective study of 424 patients undergoing knee or hip arthroplasty, two prophylaxis protocols were compared. Group 1 (190 patients, 44.8%) received cefazolin pre- and postoperatively on day 1, while group 2 (234 patients, 55.2%) received extended cefazolin (5 days postoperatively) and oral amoxicillin clavulanic acid (5 days). Early postoperative infection rates were evaluated.
RESULTS: In this study, 83.4% of 424 patients who had knee and hip arthroplasty were female. Knee operations were performed in 86.8% and hip in 13.2% of patients. The mean age showed no significant difference. There was no significant difference in periprosthetic infection rates (p=0.828) or postoperative wound complications between groups (p=0.704). No difference in wound complications and prosthesis infection rates was found between groups with risk factors (p>0.05).
DISCUSSION AND CONCLUSION: In primary joint arthroplasty, extended oral antibiotic prophylaxis did not provide additional protection against single-day antibiotic prophylaxis. The results were similar in both risk and non-risk groups. Considering antibiotic resistance, side effects and costs, it is concluded that extended prophylaxis is unnecessary. However, further large-scale studies on this subject are required.