How Well Do Oral Antibiotics Work in High Risk TJA Patients?

A new retrospective study has tried to quanitify the effectiveness (or not) of oral prophylactic antibiotics on the risk of postoperative infection for high risk total hip or total knee patients. The study researchers were able to look at 2,181 primary total knee arthroplasties (TKAs) and primary total hip arthroplasties (THAs) in an attempt to find an answer.

The study, “Extended Oral Antibiotic Prophylaxis in High-Risk Patients Substantially Reduces Primary Total Hip and Knee Arthroplasty 90-Day Infection Rate,” appears in the December 19, 2018 edition of The Journal of Bone and Joint Surgery.

Co-author Michael Meneghini, M.D., associate professor of clinical orthopedic surgery at Indiana University School of Medicine, explained the purpose and objective of this study to OTW, “Existing research and our anecdotal experience has shown that high risk patients were more likely to get an infection during the early postoperative period after hip and knee arthroplasty. It is our contention that an immunocompromised state during the first week after arthroplasty with edema, fluid and microvascular compromise creates a peri-articular milieu susceptible to infection, particularly in high-risk patients, and protection with prophylactic antibiotics during this first week after surgery minimizes the risk of infection.”

According to Meneghini, the research team found that, “The 90-day infection rates were 1.0% and 2.2% after total knee arthroplasty and total hip arthroplasty, respectively. High-risk patients without extended antibiotic prophylaxis were 4.9 and 4.0 times more likely to develop post-operative joint infection after TKA and THA, respectively, than high-risk patients with extended antibiotic prophylaxis.”

“We were very encouraged by the statistically significant and clinically meaningful four-fold decrease in 90-day postoperative infection rates in high risk patients, confirming our clinical and experienced-based hypothesis,” said Dr. Meneghini.

“Providing patients who are at high-risk for peri-prosthetic joint infection after hip or knee arthroplasty with a week of oral prophylactic antibiotics can result in a clinically meaningful reduction in postoperative infection. Prevention of even a single devastating joint infection can alleviate suffering for patients and save the healthcare systems millions on a larger scale.”

“The most commonly anticipated hesitation before implementing this protocol into practice is the fear of contributing to antimicrobial resistance (AMR). However, studies have demonstrated that surgical prophylaxis actually contributes minimally to AMR, compared to antibiotics prescribed in the ambulatory and acute-care medical setting.”