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The Bone & Joint Journal
Vol. 101-B, Issue 6_Supple_B | Pages 9 - 15
1 Jun 2019
2019 John Charnley Award: Increased risk of prosthetic joint infection following primary total knee and hip arthroplasty with the use of alternative antibiotics to cefazolin
Wyles CC Hevesi M Osmon DR Park MA Habermann EB Lewallen DG Berry DJ Sierra RJ
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Aims

The aims of this study were to characterize antibiotic choices for perioperative total knee arthroplasty (TKA) and total hip arthroplasty (THA) prophylaxis, assess antibiotic allergy testing efficacy, and determine rates of prosthetic joint infection (PJI) based on perioperative antibiotic regimen.

Patients and Methods

We evaluated all patients undergoing primary TKA or THA at a single academic institution between January 2004 and May 2017, yielding 29 695 arthroplasties (22 705 patients), with 3411 arthroplasties in 2576 patients (11.5%) having undergone preoperative allergy testing. A series of institutional databases were combined to identify allergy consultation outcomes, perioperative antibiotic regimen, and infection-free survivorship until final follow-up.

Orthopaedic Proceedings
Vol. 100-B, Issue SUPP_12 | Pages 13 - 13
1 Oct 2018
INCREASED RISK OF PERIPROSTHETIC JOINT INFECTION FOLLOWING PRIMARY TOTAL KNEE ARTHROPLASTY AND TOTAL HIP ARTHROPLASTY WITH ALTERNATIVES TO CEFAZOLIN: THE VALUE OF ALLERGY TESTING FOR ANTIBIOTIC PROPHYLAXIS
Wyles CC Hevesi M Osmon DR Park MA Habermann EB Lewallen DG Berry DJ Sierra RJ
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Introduction

First generation cephalosporins remain the gold standard perioperative antibiotic for total hip and knee arthroplasty (THA, TKA). However, some patients have documented or self-reported allergies to antibiotics, most commonly penicillin, that result in changes to perioperative antibiotic coverage. Furthermore, patients testing positive for methicillin resistant staphylococcus aureus (MRSA) represent another group where an alternative to cefazolin, typically vancomycin, is often chosen for perioperative prophylaxis. The aims of this study were to 1) characterize the antibiotic choices for perioperative prophylaxis at the time of primary TKA and THA, 2) assess the efficacy of a preoperative antibiotic allergy testing program, and 3) determine rates of periprosthetic joint infection (PJI) based on perioperative antibiotic regimen.

Methods

We evaluated all patients undergoing primary TKA or THA at a single academic institution from January 2004-May 2017, yielding a cohort of 29,695 patients. A series of institutional databases were combined to determine which patients underwent antibiotic allergy testing prior to surgery, outcomes from the allergy consultation, perioperative antibiotic management strategy, and survivorship free of infection until final follow-up.