Abstract
BackgroundInfection rates in revision (second and subsequent) major joint arthroplasty continues to be a significant issue with rates 2–3 times those of primary procedures. The effect of antibiotic and antiseptic prophylaxis on outcomes for this type of surgery has not been adequately reviewed.MethodsA systematic search of the main databases for randomized controlled trials (RCTs) evaluating antibiotics and antiseptics was conducted to evaluate the predetermined endpoints of infection.ResultsThere were five (5) RCTs identified that examined the effects of antibiotic and antiseptic prophylaxis on infections after revision total hip arthroplasty [THA] (total of 304 participants) and total knee arthroplasty [TKA] (total of 206 participants). For TKA, preoperative systemic intravenous (IV) antibiotic prophylaxis plus antibiotic cement may be effective in reducing the incidence of infection in revision TKA at 8+ years. These results however should be interpreted with caution due to the significant biases. For revision THA, there is no RCT evidence that antibiotics/antiseptics have any effect on the infection rate.ConclusionsThere is a lack of high quality data demonstrating an effect of antibiotics or antiseptics on infection rates in revision THA/TKA. Considering the rate of infections in revisions is 2-3X that of primary procedures and; there is a consensus recommendation to use similar antibiotic and antiseptic regimens in both primary and revision procedures, there is a need for high quality studies in revision THA/TKA.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-2063-4) contains supplementary material, which is available to authorized users.
Highlights
Infection rates in revision major joint arthroplasty continues to be a significant issue with rates 2–3 times those of primary procedures
It was found that preoperative systemic antibiotic prophylaxis is effective at reducing the infection rate in primary Total hip arthroplasty (THA) and that there is no high quality Randomized controlled trial (RCT) evidence antibiotic prophylaxis is effective at reducing the infection rates in primary Total knee arthroplasty (TKA)
This is a concern considering the fact that twice as many people receive primary TKA vs. THA; are 20% heavier and live 25% longer than they did back in the late 1980s–1990s; are more physically active; that diabetes is 4 times as prevalent in the US vs. 25 years ago [84] and; that diabetes along with obesity are risk factors for infection. [4,5,6,7]. This likely means at many patients will outlive their primary THA/TKA, will be sicker and require a revision procedure. This analysis supports the contention that more studies need to be initiated examining; what if any antibiotic/antiseptic prophylactic regimen(s) are effective at reducing the infection rate in revision THA/TKA
Summary
Infection rates in revision (second and subsequent) major joint arthroplasty continues to be a significant issue with rates 2–3 times those of primary procedures. The use of antibiotic and antiseptic prophylaxis for primary total hip and knee arthroplasty (referred to going forward as THA and TKA) has recently been examined in a systematic review and meta-analysis of randomized controlled trials [1]. In this analysis, it was found that preoperative systemic antibiotic prophylaxis is effective at reducing the infection rate in primary THA (vs placebo) and that there is no high quality RCT evidence antibiotic prophylaxis is effective at reducing the infection rates in primary TKA. This is especially important in revision procedures as patients undergoing these procedures have an increased risk of developing C diff infections due to their more advanced age and length of hospital stay (relative to primary THA/TKA procedures) [3]
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