Extended oral antibiotic prophylaxis did not reduce infection rates after TJA

Matthew J. Dietz, MD, FAOA

This article by Christopher N. Carender, MD, Nicholas A. Bedard, MD, and colleagues from the University of Iowa serves as an example of how we, as orthopedic surgeons, continue to struggle to find ways to mitigate the risk of prosthetic joint infection. In doing so, they took evidence presented at the American Association of Hip and Knee Surgeons’ Annual Meeting in 2017 and made changes to their clinical practice. They subsequently evaluated the short-term results of utilizing an oral prophylactic antibiotic to prevent periprosthetic joint infection and wound complications in the first 90 days postoperatively in morbidly obese patients (BMI greater than 40 kg/m²).

The authors found no evidence to support use of extended (7 to 14 days) oral antibiotics postoperatively. However, there are several limitations to this study, including its retrospective nature, that led to a heterogenous population including various antibiotics utilized for differing durations and possibly insufficient doses for this patient population. They also created a combined cohort (TKA/THA) in order to achieve adequate power in an attempt to address their proposed research question.

Since this time, research by Michael M. Kheir, MD, and colleagues has demonstrated support for the practice of extended oral antibiotics in high-risk patients through a large retrospective study. In an effort to provide the best cost-effective care for our patients and maintain good antibiotic stewardship, it is important that we continue to evaluate these efforts for which Carender and colleagues should be commended. However, an adequate answer to a question of this nature will likely require a multi-institutional randomized, controlled trial due to the infrequency of this terrible postoperative complication of significant magnitude.

Reference:

Kheir MM, et al. J Arthroplasty. 2021;doi:10.1016/j.arth.2021.01.051.