A possible risk from total hip or knee replacement procedures is periprosthetic joint infection, which can result in joint replacement failures that require additional surgeries, prolonged hospital stays, and a poor patient experience. The risk rises in patients with diabetes, chronic kidney disease, or a history of tobacco use.
Yale School of Medicine notes that, to prevent infections, many orthopedic surgeons prescribe an extended course of oral antibiotics for a week after discharge. According to a decade-long retrospective single-center cohort study by Yale researchers that tracked thousands of patients and has been published in The Journal of Arthroplasty, however, that extra week of medication may not be necessary.
The study found that “extended oral antibiotics did not significantly lower the risk of joint infections following hip or knee replacement surgery,” states Yale. “The research team found that the infection rates between those who received the regimen of oral antibiotics and those who did not were nearly identical at both the 90-day mark and one year after surgery. Even when researchers isolated the highest-risk patients, the extra medication provided no measurable benefit.”
“For years, the instinct in medicine has often been to provide an extra layer of protection, assuming that more antibiotics equals less risk,” states Daniel Wiznia, MD, an associate professor who specializes in hip and knee joint reconstruction and the study’s principal investigator in an article on Yale School of Medicine’s website. “However, this research prompts us to step back and re-evaluate our routine protocols. If an extra week of medication isn’t moving the needle on infection rates, we need to identify other treatments that might have an impact.”
Study co-author Ilda Molloy, MD, an assistant professor and orthopedic surgeon who specializes in hip and knee joint reconstruction, adds, “These findings reinforce that infection prevention is about developing coordinated, evidence-based protocols that address risk before, during, and after surgery while using antibiotics thoughtfully and responsibly.”
Nasal screenings, antiseptic skin wipes, and administration of intravenous antibiotics right before and after the incision is made have been standard practices at Yale, where the study took place. According to Dr. Wiznia, the study revealed that those “primary, immediate infection-prevention measures are incredibly robust. The work we do in the operating room and in the immediate hours following surgery is the real baseline of defense. Adding more oral antibiotics on top of that foundation later appears to offer diminishing returns.”
Ready the full Yale article here, and access the full study here.
