Evidence map›Paper›PMID 41507888›Full record

SynthesisBMC musculoskeletal disorders2026

The effect of extended postoperative oral antibiotic prophylaxis on the reinfection risk following two-stage exchange arthroplasty for hip and knee periprosthetic joint infection: a systematic review and meta-analysis.

Pei-En Kao, Chih-Wei Hsu, Allen Herng Shouh Hsu, Cheng-Ta Wu, Po-Chun Lin, Feng-Chih Kuo

Abstract readSystematic ReviewMeta-Analysis
In one paragraph

Synthesis in BMC musculoskeletal disorders, 2026. 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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1 · What the graph read from it

What it found

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

6 authors.

Pei-En KaoDepartment of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, No. 123, Dapi Road, Niaosong District, Kaohsiung, 833, Taiwan.
Chih-Wei HsuCollege of Medicine, Chang Gung University, Kaohsiung, Taiwan.
Allen Herng Shouh HsuDepartment of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, No. 123, Dapi Road, Niaosong District, Kaohsiung, 833, Taiwan.
Cheng-Ta WuDepartment of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, No. 123, Dapi Road, Niaosong District, Kaohsiung, 833, Taiwan.
Po-Chun LinDepartment of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, No. 123, Dapi Road, Niaosong District, Kaohsiung, 833, Taiwan.
Feng-Chih KuoDepartment of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, No. 123, Dapi Road, Niaosong District, Kaohsiung, 833, Taiwan. fongchikuo@cgmh.org.tw.

Funding

Kaohsiung Chang Gung Memorial Hospital, Taiwan CMRPG8N0041
6 · The paper itself

Abstract

backgroundThis study aimed to conduct a systematic review and meta-analysis to assess the impact of extended postoperative oral antibiotic prophylaxis (EPOAP) on the risk of reinfection following two-stage exchange arthroplasty for hip and knee periprosthetic joint infection (PJI).

methodsA comprehensive search of PubMed, Embase, and the Cochrane Library was conducted on January 11, 2025. Studies reporting reinfection rates in patients receiving EPOAP after two-stage exchange arthroplasty, compared to those who did not, were included. A random-effects model was used to calculate pooled risk ratios (RRs) and subgroup analyses were performed based on the duration of EPOAP use (> 2 weeks vs. ≤2 weeks) and the joint site (hip or knee).

resultsFive studies, including four retrospective cohort studies and one randomized controlled trial, with a total of 486 knees and 444 hips, were included. The meta-analysis demonstrated that EPOAP significantly reduced the risk of reinfection following two-stage exchange arthroplasty (pooled RR: 0.52; 95% confidence interval [CI]: 0.35, 0.75; p = 0.0006). Subgroup analyses yielded similar findings, with significant reductions in reinfection risk for EPOAP duration > 2 weeks (pooled RR: 0.51; 95% CI: 0.34, 0.78; p = 0.002), hip arthroplasty (pooled RR: 0.37; 95% CI: 0.20, 0.70; p = 0.002), while knee arthroplasty showed a borderline nonsignificant reduction (pooled RR: 0.64; 95% CI: 0.39, 1.04; p = 0.07). Only one cohort study reported a decreased risk of reinfection with EPOAP use ≤ 2 weeks. Two studies assessed adverse events related to EPOAP. No complications were observed among 22 patients in one cohort study, whereas 6 of 22 patients (27%) in an RCT experienced mild gastrointestinal or dermatologic reactions that led to treatment discontinuation. Additionally, another cohort study reported that 16 of 24 reinfection cases (67%) involved organisms resistant to EPOAP.

conclusionsThis meta-analysis suggests that EPOAP is associated with a reduced risk of reinfection following two-stage exchange arthroplasty for hip arthroplasty, while further research is warranted for knee cases. This approach may improve patient outcomes and help optimize post-operative antibiotic management.

Indexed as

Anti-Bacterial AgentsAntibiotic ProphylaxisArthroplasty, Replacement, HipArthroplasty, Replacement, KneeProsthesis-Related InfectionsReinfectionAdministration, OralHumansReoperationRisk FactorsAnti-Bacterial AgentsExtended postoperative oral antibiotic prophylaxisPeriprosthetic joint infectionProphylactic antibioticsReinfectionTwo-stage exchange arthroplasty

Identifiers

PMID41507888
PMCPMC12870892

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.