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No benefit from prophylactic antibiotics in routine arthroscopy

Researchers found statistically similar infection rates among knee and shoulder arthroscopy patients who did and did not receive prophylactic antibiotics.

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VANCOUVER, British Columbia — Prophylactic intravenous antibiotics do not appear to reduce infection risk following routine arthroscopic shoulder and knee surgeries, according to a retrospective study presented here.

Jack M. Bert, MD, an arthroscopic surgeon at Summit Orthopedics in St. Paul, Minn., and colleagues reviewed postoperative infection rates among 3874 routine arthroscopic knee and shoulder procedures performed over eight years. All procedures took place at a physician-owned in-office surgery center. The study included 3231 knee arthroscopies; meniscectomies comprised 86% of these cases. The remaining cases included 643 shoulder arthroscopies, 82% of which involved labral repairs and subacromial decompressions.

Bert presented the results here at the Arthroscopy Association of North America 24th Annual Meeting.

Preoperatively, 933 knee patients and 378 shoulder patients received prophylactic IV antibiotics. Postoperatively, all patients had been carefully evaluated for evidence of an infection, which was strictly defined by a positive joint aspirate, he said. The researchers found no statistical difference in rates of infection between arthroscopy patients who did and did not receive prophylactic antibiotics, regardless of the surgical procedure or joint involved. Patients who received prophylactic antibiotics had an infection rate of 0.15% and patients who did not receive the antibiotics had a rate of 0.16% (P<.5).

Previous studies have also indicated such antibiotics are unnecessary and can lead to allergic reactions, antibiotic-induced diarrhea and possible infection with Clostridium bacillaceae. Additionally, some researchers have argued that prophylactic antibiotics increase susceptibility to antibiotic-resistant infections, Bert said.

Still, arthroscopic surgeons commonly use such antibiotics. Over 90% of participants polled during a recent meeting stated that they use prophylactic antibiotics, primarily due to medicolegal concerns or because they perceive it as the standard of care in the community, he said.

“The current usage of prophylactic antibiotics prior to arthroscopic surgery appears to be a result of fear of litigation due to what is perceived to be community standards of care or habit,� he said. “The results of this study confirm there is no valid scientific reason to prescribe prophylactic antibiotics prior to routine arthroscopic surgery of the knee and shoulder,� he continued.

“However, despite the fact that no evidence-based literature supports the usage of prophylactic antibiotics ... until more literature is published substantiating the fact that prophylactic antibiotics are unnecessary and do not appear to help prevent infection, this practice ... will undoubtedly continue,� he said.

For more information:

• Bert JM, Gianini D, Nace L. Antibiotic prophylaxis for arthroscopy of the knee and shoulder: Is it necessary?. #25. Presented at the Arthroscopy Association of North America 24th Annual Meeting. May12-15, 2005. Vancouver, British Columbia, Canada.