ArticleArthroplasty today2025
Clarifying Potential Candidates for Extended Oral Antibiotic Prophylaxis: A Retrospective Analysis of Risk Factors for Infection Following Revision Hip and Knee Arthroplasty.
Article in Arthroplasty today, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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5 authors.
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Abstract
Background: Extended oral antibiotic prophylaxis (EOAP) has gained popularity after a study showed an 81% reduction in periprosthetic joint infection (PJI) among "high-risk" patients undergoing total joint arthroplasty (TJA). However, subsequent studies report inconsistent efficacy, particularly in revision TJA (rTJA) where PJI risk is higher. EOAP also conflicts with antibiotic stewardship principles. To optimize EOAP use, consensus on "high-risk" patients is needed. This study determined which preoperative comorbidities from the Inabathula comorbidities (IC) actually increase PJI risk in aseptic rTJA patients. Methods: 1995 consecutive aseptic rTJAs (1014 hips, 981 knees) met criteria for retrospective analysis. International Classification of Diseases-10 codes identified IC comorbidities, including autoimmune diseases, smoking, among others. Reoperations for PJI at 90 days and 1 year were recorded. Chi-squared/Fisher's exact tests analyzed associations between IC and PJI. Multivariable logistic regressions evaluated specific comorbidities' contributions to PJI risk. Results: 502 (50%) revision hips and 580 (60%) revision knees had at least 1 IC. Having at least 1 IC did not significantly increase the risk of developing PJI for revision hips. Only body mass index >35 kg/m Conclusions: Although over half of rTJA patients meet IC and could be eligible for EOAP, very few comorbidities significantly confer increased PJI risk. Prospective EOAP studies should consider using indications that are stricter than the IC to avoid unnecessary antibiotic use.
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