Noting the lack of data on the safety of using single-dose perioperative antibiotic in unicompartmental knee arthroplasty (UKA), researchers from Mayo Clinic in Rochester, Minnesota, evaluated 296 UKAs: 40 outpatients who received single-dose antibiotics and 256 inpatients who received 24-hour antibiotics.
Outpatient vs Inpatient Infection Risk Data From Mayo
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The study, “Single-Dose Perioperative Antibiotics Do Not Increase the Risk of Surgical Site Infection in Unicompartmental Knee Arthroplasty,” appears in the February 26, 2019 edition of The Journal of Arthroplasty.
Co-author Rafael J. Sierra, M.D., an orthopedic surgeon with Mayo Clinic explained the thinking behind the study to OTW, “An increasing number of outpatient hip and knee replacements are being done in the U.S. Guidance to antibiotic prophylaxis is lacking as patients leave the hospital prior to completing 24-hour recommended IV prophylaxis dosing.”
After conducting the study, Dr. Sierra and his colleagues found that surgical site infections occurred in 2 of the 296 cases (0.7%) studied. Of the 256 patients who received unicompartmental knee arthroplasty, 2 of 256 inpatient UKAs (0.8%) had surgical site infections. And, finally, of the 40 outpatient unicompartmental knee arthroplasty patients, none had a surgical site infections. One patient did have a deep infection which was diagnosed 6 weeks postoperatively and which required a 2-stage exchange and conversion to total knee arthroplasty. The other patient with a surgical site infection had a superficial infection which was treated with 2 weeks of oral antibiotics.
Dr. Sierra summarized the conclusions of the study to OTW, “For unicompartmental arthroplasty, one preoperative dose did not increase the risk of infection in comparison to 24-hour routine prophylaxis.”
“For unicompartmental arthroplasty, one dose of preop IV antibiotic prophylaxis is all that is needed—no need for oral antibiotics to go home. Further studies looking at 1 dose of preop IV antibiotic prophylaxis for outpatient TKA [total knee arthroplasty] and THA [total hip arthroplasty] should be performed to determine if the same dosing is effective and safe for those undergoing surgery as an outpatient.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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