Abstract
An orthopaedic surgery is a clean and successful surgery, as widely demonstrated by several long-term series particularly for hip and knee procedures. The annual worldwide increase in the number of hip and knee implants is leading to a proportional rise of the complication rates: among these, infections to date represent one of the major risks of failure, reaching up to 15 and 25 % of the indications to revision in hip and knee surgery, respectively. It is hard to define a unique protocol of antibiotic prophylaxis in orthopaedic surgery. However, recently the best available evidence has suggested some specific guidelines worldwide accepted. Antibiotic prophylaxis in orthopaedic surgery should be based on the patients’ medical history and health status and set on the local hospital conditions or risk factors; moreover, the duration of the prophylaxis should be varied in cases of prolonged surgical time or intraoperative complications. The antibiotic of first choice should be a first- or second-generation cephalosporin or, in cases of actual specific risks, a glycopeptide, both by intravenous administration. The first dose of antibiotic should be administered 30–60 min before skin incision and always before the use of a tourniquet. Finally, the duration of the prophylaxis should be prolonged at least for 24 h after surgery.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
AAOS recommendations for the use of intravenous antibiotic prophylaxis in primary total joint arthroplasty (2004) www.aaos.org
Al-Buhairan B, Hind H, Hutchinson A (2008) Antibiotic prophylaxis for wound infections in total joint arthroplasty: a systematic review. J Bone Joint Surg Br 90:915–919
Al-Maiyah M, Hill D, Bajwa A et al (2005) Bacterial contaminants and antibiotic prophylaxis in total hip arthroplasty. J Bone Joint Surg Br 87:1256–1258
Babkin Y, Raveh D et al (2007) Incidence and risk factors for surgical infection after total knee replacement. Scand J Infect Dis 10:890–895
Berry DJ, Bozic K (2010) Current practice patterns in primary hip and knee arthroplasty among members of the American Association of Hip and Knee Surgeons. J Arthroplasty 25(6 Suppl):2–4
Blom AW, Brown J, Taylor AH et al (2004) Infection after total knee replacement. J Bone Joint Surg Br 86B:688–691
Bratzler DW et al (2004) Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project. Clin Infect Dis 38:1706–1715
Carrega G, Bartolacci V, Burastero G et al (2008) Etiology of prosthetic joint infections in a tertiary care centre in Italy. Infez Med 16(4):204–208
Carulli C, Villano M, Bucciarelli G et al (2011) Painful knee arthroplasty: definition and overview. Clin Cases Miner Bone Metab 8:23–25
Carulli C, Matassi F, Nistri L et al (2012) Long-term survival of a flat-on-flat total condylar knee arthroplasty fixed with a hybrid cementing technique for tibial components. J Long Term Eff Med Implants 22:305–312
Classen DC, Evans RS, Pestotnik SL et al (1992) The timing of prophylactic administration of antibiotics and the risk of surgical wound infection. N Engl J Med 326:281–286
Corbett KL, Losina E, Nti AA et al (2010) Population-based rates of revision of primary total hip arthroplasty: a systematic review. PLoS One 5:e13520
Crabtree TD, Palletier SJ, Gleason TG et al (1999) Clinical characteristics and antibiotic utilization in surgical patients with Clostridium difficile-associated diarrhea. Am Surg 65:507–511
Cranny G, Elliot R, Weatherly H et al (2008) A systematic review and economic model of switching from non-glycopeptide to glycopeptide antibiotic prophylaxis for surgery. Health Technol Assess 12:1–147
de Beer J, Petruccelli D, Rotstein C et al (2009) Antibiotic prophylaxis for total joint replacement surgery: results of a survey of Canadian orthopaedic surgeons. Can J Surg 52:E229–E234
Engesaeter LB, Lie SA, Espehaug B et al (2003) Antibiotic prophylaxis in total hip arthroplasty: effects of antibiotic prophylaxis seismically and in bone cement on the revision rate of 22170 primary hip replacements followed 0-14 years in the Norwegian Arthroplasty Register. Acta Orthop Scand 74:644–651
Fonseca SN, Kunzle SR, Junqueira MJ et al (2006) Implementing 1-dose antibiotic prophylaxis for prevention of surgical site infection. Arch Surg 141:1109–1113
Fulkerson E, Valle CJ, Wise B et al (2006) Antibiotic susceptibility of bacteria infecting total joint arthroplasty sites. J Bone Joint Surg Am 88:1231–1237
Furuno JP, McGregor JC, Harris AD et al (2006) Identifying groups at high risk for carriage of antibiotic resistant bacteria. Arch Intern Med 166:580–585
Gemmel GC, Edwards DI, Weatherly H, Joint working party of the British Society for Antimicrobial Chemotherapy, Hospital Infection Society and Infection Control Nurses Association et al (2006) Guidelines for the prophylaxis and treatment of methicillin-resistant Staphylococcus aureus (MRSA) infection in UK. J Antimicrob Chemother 57:589–608
Glenny AM, Song F (1999) Antimicrobial prophylaxis in total hip replacement: a systematic review. Health Technol Assess 3:1–57
Goyal N, Miller A, Tripathi M et al (2013) Methicillin-resistant Staphylococcus aureus (MRSA): colonisation and pre-operative screening. Bone Joint J 95B:4–9
Hacek DM, Robb WJ, Paule SM et al (2008) Staphylococcus aureus nasal decolonization in joint replacement surgery reduces infection. Clin Orthop Relat Res 466:1349–1355
Hamilton H, Jamieson J (2008) Deep infection in total hip arthroplasty. Can J Surg 51:111–117
Heath AF (1991) Antimicrobial prophylaxis for arthroplasty and total joint replacement: discussion and review of published clinical trials. Pharmacotherapy 11:157–163
Innocenti M, Carulli C, Matassi F et al (2014) Total knee arthroplasty in patients with hypersensitivity to metals. Int Orthop 38:329–333
Jämsen E, Furnes O, Engesæter LB, Konttinen YT et al (2010) Prevention of deep infection in joint replacement surgery: a review. Acta Orthop 81(6):660–666
Jenkins PJ, Teoh K, Simpson PM et al (2010) Breusch Clostridium difficile in patients undergoing primary hip and knee replacement. J Bone Joint Surg Br 92:994–998
Kalmeijer DM, Coertjens H, van Nieuwland-Bollen PM et al (2002) Surgical site infections in orthopedic surgery: the effect of mupirocin nasal ointment in a double-blind, randomized, placebo-controlled study. Clin Infect Dis 35:353–358
Kock R, Becker K, Cookson B et al (2010) Methicillin-resistant Staphylococcus aureus (MRSA): burden of disease and control challenges in Europe. Euro Surveill 15:19688
Linee Guida ISS (2011) SNLG Antibioticoprofilassi nell’adulto
Matar WY, Jafari MS, Restrepo C et al (2010) Preventing infection in total joint arthroplasty. J Bone Joint Surg Br 92-A(Suppl 2):36–46
Meehan J, Jamali AA, Nguyen H (2009) Prophylactic antibiotics in hip and knee arthroplasty. J Bone Joint Surg Am 91(10):2480–2490
Merollini KMD, Zheng H, Graves N (2013) Most relevant strategies for preventing surgical site infection after total hip arthroplasty: guideline recommendations and expert opinion. Am J Infect Control 41:221–226
Nixon M, Jackson B, Varghese P et al (2006) Methicillin-resistant Staphylococcus aureus in orthopaedic wards: incidence, spread, mortality, cost and control. J Bone Joint Surg Br 88:812–817
Page CP et al (1993) Antimicrobial prophylaxis for surgical wounds. Guidelines for clinical care. Arch Surg 128:79–88
Parvizi J (2013) Prosthetic joint infection: practical management guide. Jaypee Brothers Medical Publishers New Delhi
Parvizi J, Gehrke T (2013) Proceedings of the international consensus meeting on periprosthetic joint infection. Data Trace Publishing Company, Brooklandville
Phillips JE, Crane TP, Noy M et al (2006) The incidence of deep prosthetic infections in a specialist orthopaedic hospital: a 15-year prospective survey. J Bone Joint Surg Br 88:943–948
Pulido L, Ghanem E, Joshi A et al (2008) Periprosthetic joint infection: the incidence, timing, and predisposing factors. Clin Orthop Relat Res 466:1710–1715
Rao N, Cannella B, Crossett LS et al (2008) A preoperative decolonization protocol for staphylococcus aureus prevents orthopaedic infections. Clin Orthop Relat Res 466:1343–1348
Ritter MA (2009) The anatomical graduated component total knee replacement. A long-term evaluation with 20-years survival analysis. J Bone Joint Surg Br 91:45–49
Sewick A, Makani A, Wu C et al (2012) Does dual antibiotic prophylaxis better prevent surgical site infections in total joint arthroplasty? Clin Orthop Relat Res 470:2702–2707
Sharkey PF, Hozack WJ, Rothman RH et al (2002) Why are total knee arthroplasties failing today? Clin Orthop Relat Res 404:7–13
Smith EB, Wynne R, Joshi A et al (2012) Is it time to include vancomycin for routine perioperative antibiotic prophylaxis in total joint arthroplasty patients? J Arthroplasty 27(8 Suppl):55–60
Soriano A et al (2006) Eur J Clin Microbiol Infect Dis 25:35–38
Southorn PA, Plevak DJ, Wright AJ, Wilson WR (1986) Adverse effects of vancomycin administered in the perioperative period. Mayo Clin Proc 61:721–724
Stefánsdóttir A, Johansson Å, Lidgren L et al (2013) Bacterial colonization and resistance patterns in 133 patients undergoing a primary hip- or knee replacement in Southern Sweden. Acta Orthop 84(1):87–91
Tan JA, Naik VN, Lingard L (2006) Exploring obstacles to proper timing of prophylactic antibiotics for surgical site infections. Qual Saf Health Care 1:32–38
Tang WM, Chiu KY, Ng TP et al (2003) Efficacy of a single dose of cefazolin as a prophylactic antibiotic in primary arthroplasty. J Arthroplasty 18:714–718
Toossi N, Adeli B, Timperley AJ et al (2013) Acetabular components in total hip arthroplasty: is there evidence that cementless fixation is better? J Bone Joint Surg Am 95:168–174
Tyllianakis ME, Karageorgos AC, Marangos MN et al (2010) Antibiotic prophylaxis in primary hip and knee arthroplasty: comparison between cefuroxime and two specific antistaphylococcal agents. J Arthroplasty 25(7):1078–1082
Van Kasteren ME et al (2007a) Antibiotic prophylaxis and the risk of surgical site infection following total hip arthroplasty; timely administration is the most important factor. Clin Infect Dis 44:92–97
van Kasteren ME, Mannien J, Ott A et al (2007b) Antibiotic prophylaxis and the risk of surgical site infections following total hip arthroplasty: timely administration is the most important factor. Clin Infect Dis 44:921–927
Vardakas KZ et al (2005) Perioperative anti-infective prophylaxis with teicoplanin compared to cephalosporins in orthopaedic and vascular surgery involving prosthetic material. Clin Microbiol Infect 11:775–777
Villano M, Carulli C, Puccini S et al (2011) Painful knee arthroplasty: surgical approach. Clinical Cases Miner Bone Metab 8:26–28
Willis-Owen CA, Konyves A, Martin DK (2010) Factors affecting the incidence of infection in hip and knee replacement. An analysis of 5277 cases. J Bone Joint Surg Br 92B:1128–1133
Wymenga A, von Horn J, Theeuwes A et al (1992) Cefuroxime for prevention of post-operative coxitis. One versus three doses tested in a randomized multicenter study of 2651 arthroplasties. Acta Orthop Scand 63:19–24
Author information
Authors and Affiliations
Corresponding authors
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2015 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Innocenti, M., Riccio, G., Carulli, C., Ristori, G., Matassi, F., Civinini, R. (2015). Perspectives: The Best Prophylaxis for Primary Arthroplasty. In: Baldini, A., Caldora, P. (eds) Perioperative Medical Management for Total Joint Arthroplasty. Springer, Cham. https://doi.org/10.1007/978-3-319-07203-6_23
Download citation
DOI: https://doi.org/10.1007/978-3-319-07203-6_23
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-07202-9
Online ISBN: 978-3-319-07203-6
eBook Packages: MedicineMedicine (R0)