Perspectives: The Best Prophylaxis for Primary Arthroplasty

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.