JOA - 2026-06-01 - Journal Article
Extended Antibiotic Use in Total Knee Arthroplasty Is Not Associated With Decreased Periprosthetic Joint Infection Rates.
Tay AYW, Liow LMH, Pang HN, Tay DKJ, Yeo SJ, Tan AHC
Topics
Key Takeaway
Extended antibiotic prophylaxis (>24 hours) did not reduce PJI rates compared to standard prophylaxis (≤24 hours) in primary TKA across 17,223 cases (0.34% vs 0.40%, P=0.67).
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Summary
This registry-based retrospective cohort study asked whether extended antibiotic prophylaxis (>24 hours) reduces PJI requiring reoperation compared to standard prophylaxis (≤24 hours) in primary TKA. Of 17,223 TKAs performed 2000–2018, 15,160 received standard and 2,063 received extended prophylaxis; PJI occurred in 0.40% vs 0.34% respectively (P=0.67). No benefit was identified in high-risk subgroups (CCI >2, diabetes, CKD, obesity), and Oxford Knee Score, SF-36, and satisfaction scores were equivalent at two years.
Key Limitation
Retrospective registry design cannot exclude confounding by indication—surgeons selectively prescribing extended antibiotics to higher-risk patients may have masked a true benefit, and antibiotic agent, dosing, and specific comorbidity severity were not granularly controlled.
Original Abstract
BACKGROUND
Prophylactic antibiotics are essential in preventing periprosthetic joint infection (PJI) in total knee arthroplasty (TKA), but the optimal duration of administration remains controversial. Existing studies lack long-term follow-up, suffer from small sample sizes, and are limited by cohort heterogeneity. This study aimed to determine whether the duration of prophylactic antibiotics affects PJI rates in TKA.
METHODS
Registry data of 17,223 TKAs performed between 2000 and 2018 were reviewed. Patients were grouped by receiving standard (≤ 24 hours) or extended (> 24 hours) antibiotics. The prevalence of PJI requiring reoperation was recorded for both groups, with clinical assessment at preoperative, 6-month, and 2-year follow-up using the Oxford Knee Score, Short Form-36, and postoperative satisfaction. Of the 17,223 patients, 15,160 (88.0%) received standard-course antibiotics, and 2,063 (12.0%) received extended-course antibiotics.
RESULTS
A total of 68 (0.39%) PJI cases were identified: 61 in the standard group (0.40%) and seven in the extended group (0.34%, P = 0.67). High-risk patients (e.g., Charlson Comorbidity Index > 2, diabetes, chronic kidney disease, obesity) on extended-course antibiotics did not show a reduced PJI rate. No differences in outcome measures or satisfaction scores were noted at two years.
CONCLUSIONS
Extended antibiotic prophylaxis in TKA was not associated with reduced PJI rates in both normal and high-risk patients at two years. The routine use of extended-course antibiotics in TKA should be discouraged. Certain high-risk patient groups may still benefit from extended-course antibiotics, and future studies should focus on identifying them.
LEVEL OF EVIDENCE
Level III, Retrospective Cohort Study.