Abstract
BackgroundThe aim of this study was to compare the intraosseous concentrations and the inhibitory effects on the growth of Staphylococcus aureus of 1 g versus 2 g of intravenous (IV) prophylactic cefazolin in total knee arthroplasty (TKA).Materials and methodsEighteen patients (21 knees) with primary knee osteoarthritis were divided into two groups receiving 1 g (12 patients: 14 knees) versus 2 g (six patients: seven knees) IV prophylactic cefazolin prior to the incision in TKA. Subchondral bone samples (proximal tibia, distal femur) were taken during the operation. These samples were analyzed for intraosseous concentration of cefazolin and their inhibitory effects on the growth of S. aureus, using high-performance liquid chromatography (HPLC) and agar disc diffusion bioassays.ResultsThe mean intraosseous concentration in the 2 g dose group was significantly higher than in the 1 g dose group in the proximal tibia (p = 0.007) and distal femur (p = 0.016). There were no significant differences between the two groups in terms of mean inhibitory effects in the proximal tibia or distal femur (p > 0.05). No significant correlations were found between the intraosseous concentrations and inhibitory effects in the proximal tibia (r = 0.18, p = 0.52) and distal femur (r = −0.29, p = 0.30).ConclusionIV cefazolin at a dose of 2 g produced greater intraosseous concentrations overall than a dose of 1 g. However, the higher intraosseous concentrations did not correlate with higher inhibitory effects.Level of evidenceLevel III.
Highlights
Prophylactic antibiotics are known to reduce the risk of perioperative and/or postoperative infection [1,2,3]
From Pearson’s correlation analyses, there were no significant correlations between the levels of intraosseous concentration and inhibitory effects seen in the proximal tibia (r = 0.18, p = 0.52) and distal femur (r = -0.29, p = 0.30)
Based on the present study, we found that the mean intraosseous concentrations in the group receiving 2 g of cefazolin were significantly higher than in the group receiving 1 g, at the proximal tibia (p = 0.007) and distal femur (p = 0.016)
Summary
Prophylactic antibiotics are known to reduce the risk of perioperative and/or postoperative infection [1,2,3]. The current literature recommends the intravenous (IV) administration of cefazolin, 1–2 g [1], within 1 h prior to making the incision This antibiotic may be repeated every 2–5 h during the operation and should be stopped within 24 h following the operation [8, 9]. The aim of this study was to compare the intraosseous concentrations and the inhibitory effects on the growth of Staphylococcus aureus of 1 g versus 2 g of intravenous (IV) prophylactic cefazolin in total knee arthroplasty (TKA). Subchondral bone samples (proximal tibia, distal femur) were taken during the operation These samples were analyzed for intraosseous concentration of cefazolin and their inhibitory effects on the growth of S. aureus, using high-performance liquid chromatography (HPLC) and agar disc diffusion bioassays
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