Antibiotics Prophylaxis for Knee Arthroplasty: Benefits and Problems

A special issue of Antibiotics (ISSN 2079-6382). This special issue belongs to the section "Antibiotics Use and Antimicrobial Stewardship".

Deadline for manuscript submissions: closed (31 May 2023) | Viewed by 8928

Special Issue Editor

Department of Orthopedics and Traumatology, Johannes Kepler University, Linz, Austria
Interests: knee arthroplasy; revision knee arthroplasty; multiligament surgery; knee trauma; periprosthetic infection management
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Knee arthroplasty infection is one of the biggest surgical challenges we face in our practice. The strongest weapon we have is prevention, antibiotic prophylaxis being one of the cornerstones, if not the single most important factor. The quickly evolving antibiotic resistance observed across all disciplines is present in our field as well.

This Special Issue is focused on antibiotic agents and application strategies of antibiotic prophylaxis in primary, revision, and tumour knee arthroplasty. Comparisons of agents, the use of multiple agents, comparisons of differing application lengths, between-center comparisons, differing application pathways, and adverse reactions to prophylaxis are some of the topics of interest. Original research manuscripts, short communications, and reviews are welcomed.

Dr. Antonio Klasan
Guest Editor

Manuscript Submission Information

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Keywords

  • antibiotic prophylaxis
  • knee arthroplasty
  • revision knee arthroplasty
  • antibiotics adverse reactions
  • intravenous antibiotics
  • intraosseous regional application

Published Papers (5 papers)

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Research

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11 pages, 1145 KiB  
Article
International Survey of Practice for Prophylactic Systemic Antibiotic Therapy in Hip and Knee Arthroplasty
by Thomas Parsons, Jonathan French, Takeshi Oshima, Francisco Figueroa, Thomas Neri, Antonio Klasan and Sven Putnis
Antibiotics 2022, 11(11), 1669; https://doi.org/10.3390/antibiotics11111669 - 21 Nov 2022
Cited by 3 | Viewed by 1307
Abstract
(1) Background: Prophylactic systemic antibiotics are acknowledged to be an important part of mitigating prosthetic joint infections. Controversy persists regarding optimal antibiotic regimes. We sought to evaluate current international antibiotics guidelines for total joint arthroplasty (TJA) of the hip and knee. (2) Methods: [...] Read more.
(1) Background: Prophylactic systemic antibiotics are acknowledged to be an important part of mitigating prosthetic joint infections. Controversy persists regarding optimal antibiotic regimes. We sought to evaluate current international antibiotics guidelines for total joint arthroplasty (TJA) of the hip and knee. (2) Methods: 42 arthroplasty societies across 6 continents were contacted and their published literature reviewed. (3) Results: 17 societies had guidelines; of which 11 recommended an antibiotic agent or antibiotic class (10—cephalosporin; 1—cloxacillin); 15 recommended antibiotic infusion within an hour of incision and 10 advised for post-operative doses (8—up to 24 h; 1—up to 36 h; 1—up to 48 h). (4) Conclusions: Prophylactic antibiotic guidelines for TJA are often absent or heterogenous in their advice. Full article
(This article belongs to the Special Issue Antibiotics Prophylaxis for Knee Arthroplasty: Benefits and Problems)
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8 pages, 362 KiB  
Article
Comparison of Patient-Reported Outcomes Measures and Quality-Adjusted Life Years Following One- and Two-Stage Septic Knee Exchange
by Maximilian Budin, Salahulddin Abuljadail, Giacomo Traverso, Seper Ekhtiari, Thorsten Gehrke, Rachel Sommer and Mustafa Citak
Antibiotics 2022, 11(11), 1602; https://doi.org/10.3390/antibiotics11111602 - 11 Nov 2022
Cited by 1 | Viewed by 1034
Abstract
(1) Background: Periprosthetic joint infection (PJI) can be managed with one- or two-stage revision surgery protocol. Despite several studies analyzing the eradication rates between both procedures, there are no comparative studies that analyze patient-reported outcome measures (PROMs) and quality-adjusted life years (QALYs) in [...] Read more.
(1) Background: Periprosthetic joint infection (PJI) can be managed with one- or two-stage revision surgery protocol. Despite several studies analyzing the eradication rates between both procedures, there are no comparative studies that analyze patient-reported outcome measures (PROMs) and quality-adjusted life years (QALYs) in both treatment strategies. (2) Methods: All patients who underwent a two-stage knee revision between January 2017 to December 2018, due to a periprosthetic joint infection were included in the study. From the time interval, we selected a comparative group with the one-stage septic procedure. All patients received the following questionnaires: Oxford Knee Score, EQ-5D-5L, SSQ-8, and the SF-36. Additionally, demographic patient data were collected. The quality-adjusted life years (QALY) were calculated using the EQ-5D-5L. (3) Results: A total of 35 patients with a mean age of 67.7 years (SD = 8.9) were included in the final evaluation. The mean follow-up period was 54.5 months (SD = 5.5). There was no statistically significant difference regarding the Charlson Comorbidity Index (CCI), postoperative complications, or all evaluated questionnaires. There was no statistically significant difference in QALYs between the one- and two-stage revision. (4) Conclusion: Our study results show that the one-stage revision for PJI achieves similar PROMs compared to two-stage revision. Full article
(This article belongs to the Special Issue Antibiotics Prophylaxis for Knee Arthroplasty: Benefits and Problems)
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10 pages, 936 KiB  
Article
The Impact of Patient-Reported Penicillin or Cephalosporin Allergy on the Occurrence of the Periprosthetic Joint Infection in Primary Knee and Hip Arthroplasty
by Stella Stevoska, Verena Behm-Ferstl, Stephanie Zott, Christian Stadler, Sophie Schieder, Matthias Luger, Tobias Gotterbarm and Antonio Klasan
Antibiotics 2022, 11(10), 1345; https://doi.org/10.3390/antibiotics11101345 - 02 Oct 2022
Cited by 3 | Viewed by 1305
Abstract
Reducing the risk of periprosthetic joint infections (PJI) requires a multi-pronged strategy including usage of a prophylactic antibiotic. A history of penicillin or cephalosporin allergy often leads to a change in prophylactic antibiotic regimen to avoid serious side effects. The purpose of the [...] Read more.
Reducing the risk of periprosthetic joint infections (PJI) requires a multi-pronged strategy including usage of a prophylactic antibiotic. A history of penicillin or cephalosporin allergy often leads to a change in prophylactic antibiotic regimen to avoid serious side effects. The purpose of the present retrospective study was to determine incidence of PJI based on perioperative antibiotic regimen in total hip arthroplasty (THA), total knee arthroplasty (TKA) or unicompartmental knee arthroplasty (UKA). A review of all primary THAs, primary TKAs and primary UKAs, undertaken between 2011 and 2020 in a tertiary referral hospital, was performed. The standard perioperative antibiotic for joint arthroplasty (JA) in the analyzed tertiary hospital is cefuroxime. There were no differences in prophylactic antibiotic regimen over time. In 7.9% (211 of 2666) of knee arthroplasties and in 6.0% (206 of 3419) of total hip arthroplasties, a second-line prophylactic antibiotic was used. There was no statistically significant higher occurrence of PJI between the first-line and second-line prophylactic antibiotic in knee arthroplasties (p = 0.403) as well as in total hip arthroplasties (p = 0.309). No relevant differences in age, American Society of Anesthesiologists (ASA) score and body mass index (BMI) between the groups were observed. Full article
(This article belongs to the Special Issue Antibiotics Prophylaxis for Knee Arthroplasty: Benefits and Problems)
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Review

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11 pages, 4498 KiB  
Review
Intraosseous Regional Administration of Prophylactic Antibiotics in Total Knee Arthroplasty
by Zoe Wells, Mark Zhu and Simon W. Young
Antibiotics 2022, 11(5), 634; https://doi.org/10.3390/antibiotics11050634 - 09 May 2022
Cited by 2 | Viewed by 2840
Abstract
Prosthetic joint infection (PJI) after total knee arthroplasty is a devastating complication. With the development of antibiotic resistance, a safe and effective means of delivering antibiotic prophylaxis is needed. Intraosseous regional antibiotics (IORA) achieve higher local concentrations of antibiotics with fewer systemic side [...] Read more.
Prosthetic joint infection (PJI) after total knee arthroplasty is a devastating complication. With the development of antibiotic resistance, a safe and effective means of delivering antibiotic prophylaxis is needed. Intraosseous regional antibiotics (IORA) achieve higher local concentrations of antibiotics with fewer systemic side effects. Previous studies have proven the safety of IORA, whereas animal models have proven it to be more effective than intravenous antibiotics for preventing infection following surgery. Recently, large-scale retrospective studies have also demonstrated lower PJI rates following TKA when IORA is used when compared to routine intravenous prophylaxis. In this article, we propose an evidence-based method for the administration of intraosseous antibiotics in TKA, cover the up-to-date data supporting its use, and explore future directions for additional research. Full article
(This article belongs to the Special Issue Antibiotics Prophylaxis for Knee Arthroplasty: Benefits and Problems)
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Other

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12 pages, 605 KiB  
Systematic Review
Antibiotic Prophylaxis in One-Stage Revision of Septic Total Knee Arthroplasty: A Scoping Review
by Carlo Ciccullo, Thomas Neri, Luca Farinelli, Antonio Gigante, Rémi Philippot, Frederic Farizon and Bertrand Boyer
Antibiotics 2023, 12(3), 606; https://doi.org/10.3390/antibiotics12030606 - 18 Mar 2023
Viewed by 1783
Abstract
Background: Total knee replacement (TKA) is becoming a routine procedure in orthopedic surgery. One of the possible complications of this surgery is periprosthetic joint infection (PJI). The purpose of this study is to identify, through a literature review, which antibiotic is used as [...] Read more.
Background: Total knee replacement (TKA) is becoming a routine procedure in orthopedic surgery. One of the possible complications of this surgery is periprosthetic joint infection (PJI). The purpose of this study is to identify, through a literature review, which antibiotic is used as prophylaxis for septic one-stage revision TKA and what is the rationale for its use. Methods: We searched: MEDLINE, Embase, PsycINFO on Ovid, the Cochrane Library, and the Google Scholar Database. The searches were limited by date (January 2005 to September 2022) and to the English language. All types of original research were considered, including prospective or retrospective longitudinal studies, cross-sectional studies, and randomized trials. The specific search terms were ((antibiotic [MeSH]) AND (prophylaxis)) and (TKA OR TKR OR “Arthroplasty, Replacement, Knee” [MeSH] OR ((knee) adj2 (replace* OR arthroplasty* OR prosthe*))). Results: Despite our research efforts, we found no article capable of answering the question of which antibiotic to use as surgical prophylaxis for a septic revision one-stage TKA. Conclusions: Although the research results are inconclusive, we would recommend using the same antibiotic prophylaxis as for primary joint replacement, i.e., cefazolin, as it was recommended for its low side effect rate and relative effectiveness. Full article
(This article belongs to the Special Issue Antibiotics Prophylaxis for Knee Arthroplasty: Benefits and Problems)
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