Antibiotic Prophylaxis to Prevent Infection in Total Knee Arthroplasty

Abstract

Total knee arthroplasty (TKA) is one of the most frequent and successful procedures performed in orthopedic surgery. Despite its safety, complications are still present. Infection is one of the more devastating complications in TKA as it places a significant burden on patients, surgeons, and health systems. Surgical site infection in non-contaminated surgery still affects 2–5% of patients. These data highlight the importance of prophylactic measures in preventing infection following TKA. The key point on choosing antibiotic prophylaxis is the spectrum of action and the penetration into the bone and periarticular tissues. Antibiotics should cover the most frequent microorganisms causing postoperative infection. It should achieve a high enough concentration (at least the minimum inhibitory concentration) in the serum and bone and maintain this over time. For standard antibiotic prophylaxis, drug administration should be done during the hour before incision. Cephalosporins are the most widely used antibiotics for periprosthetic joint infection prophylaxis during the last decades in the USA and Europe. They are effective against gram-positive organisms, aerobic gram-negative bacilli, and anaerobes. Despite the great advantages, cefazolin (1–3 g depending on body weight every 2–5 h) is not effective against methicillin-resistant Staphylococcus aureus (MRSA). For this, increased prevalence of MRSA should be taken into account to decide if cefazolin is the best option. However, clindamycin (90 mg every 3–6 h) and vancomycin (15/kg every 6–12 h) are appropriate options when cephalosporins are contraindicated (i.e., allergy) or when risk factors for antibiotic-resistant organism are present.