UK Study: No Difference Between 5 TKA Prophylaxis Regimes

In the constant hunt for the most effective antibiotic prophylaxis for total knee replacement (TKR), a team of UK researchers performed a study titled “A comparative study of 5 different antibiotic prophylaxis regimes in 4500 total knee replacements.” This was published online December 18, 2018 in the Journal of Clinical Orthopaedics and Trauma.

Satish Babu, M.R.C.S. a Specialist Orthopaedic Registrar at Frimley Park Hospital in the UK and co-author explained the rationale behind the study to OTW. “In the institution where the work was carried out, the recommended antibiotic prophylaxis protocol for TKR was changed several times due to side effects and perceived deficiencies of existing regimens.”

“Despite this, there was no obvious difference in observed deep infection rates. Furthermore, there is widespread variation in the antibiotic prophylaxis regimens used between surgeons throughout the UK and we wanted to examine which, if any, were better.”

So Dr. Babu and his colleagues put together a retrospective study of prospectively collected data on a total of 4,500 elective knee replacements over a nine-year period at a district general hospital. The investigators collected data regarding an antibiotic regime, patient characteristics, infection (treatment, infective agents, sensitivities) and complications. They then identified five different antibiotic regimes that have been used in elective knee arthroplasty at their institution. In total, the researchers identified 40 patients who had a deep infection.

Interestingly, said Dr. Babu, “Rates of deep surgical site infection were not significantly different between the five groups. There were no significant differences in the rates of deep surgical site infection after TKR between the five regimes examined in our study. Rather than adopting a ‘one size fits all’ approach, clinicians should exercise judgment in choosing antibiotic prophylaxis protocols based on patient, surgical and environmental factors.”

“Our study produced no evidence to say one particular antibiotic regimen was superior to another when considering prophylaxis for TKR. We recommend the choice of antibiotic prophylaxis for TKR should be made locally at the institution where the surgery is being done based on pathogen virulence in the area, drug resistance and cost.”