Does Extended Oral Antibiotic Prophylaxis Work?

How well (or not) does extended oral antibiotic prophylaxis work after aseptic revision total hip arthroplasty (THA)? A team of researchers from Mayo Clinic in Minnesota designed a retrospective study and collected data from 1,107 aseptic revision THAs to see if an answer to that question emerged.

The research, “Extended Oral Antibiotic Prophylaxis After Aseptic Revision Total Hip Arthroplasty: Does It Decrease Infection Risk?” was published in the July 4, 2022, edition of The Journal of Arthroplasty.

Matthew Abdel, M.D., Andrew A. and Mary S. Sugg Professor of Orthopedic Surgery and chair of the Division of Orthopedic Surgery Research at Mayo Clinic and co-author described the genesis of this study to OTW, “Extended oral antibiotic prophylaxis is becoming more common after a landmark study by Dr. Michael Meneghini showing decreased risk of infection in high-risk patients undergoing primary arthroplasties.”

“In revision procedures, those are some of the highest risk patients, and at Mayo Clinic, a subset of us have been providing extended oral antibiotic prophylaxis for 7-, 10-, or 14-days while awaiting intraoperative cultures for the past 10 years.”

For this study, the researchers looked at a subset of 370 patients who received extended oral antibiotic prophylaxis >24 hours perioperatively, comparing them to 737 who did not. Their outcomes of interest included cumulative probabilities of any infection, periprosthetic joint infection (PJI), and re-revision or reoperation for infection.

Using the 2011 Musculoskeletal Infection Society criteria, the researchers defined aseptic revision THA as “a surgical intervention involving arthroplasty of at least one component, including isolated head-liner exchanges, and no evidence of infection.” All procedures were done at the same institution and every patient received the same standardized perioperative care according to the Mayo Clinic total joint pathway.

The researchers found that the cumulative probability of any infection after aseptic revision THA was 2.3% at 90 days, 2.7% at 1 year, and 3.5% at 5 years. The cumulative probability of PJI was 1.7% at 90 days, 2.1% at 1 year, and 2.8% at 5 years.

“In this study,” explained Dr. Abdel to OTW, “we found a trend towards increased risk of any infection (Hazard Ratio=2.6), PJI (Hazard Ratio=2.6), and re-revision (Hazard Ratio=6.5), and or reoperation (Hazard Ratio=2.3) for infection in patients who did not have extended oral antibiotic prophylaxis at final clinical follow-up.”

“This is important as revision procedures often include extensive tibial and femoral fixation that is more difficult to remove when infection occurs, and things we can do to prevent such infections is paramount.”