Der Orthopäde

, Volume 47, Issue 3, pp 246–253 | Cite as

Value of antibiotic prophylaxis in routine knee arthroscopy

A retrospective study
  • Yongjian Qi
  • Xu Yang
  • Zhengqi Pan
  • Hua Wang
  • Liaobin Chen



Prophylactic antibiotic use prior to routine knee arthroscopy remains controversial. It is important to know whether antibiotics help decrease the surgical site infection (SSI) rate. Our aims were to assess the efficacy of antibiotic prophylaxis in preventing SSI and to identify risk factors for SSI following routine knee arthroscopy without an implant.


A retrospective study was conducted using the electronic medical records at the authors’ hospital to identify patients that underwent routine knee arthroscopy without an implant between October 2010 and October 2016. Data on demographics, clinical characteristics and antibiotic administration were extracted. Arthroscopic diagnosis, debridement, partial or complete meniscectomy, arthroscopic shaving and microfracture, removal of loose bodies, synovectomy and lateral retinacular release were included. Complex knee arthroscopy with an implant was excluded. Patients were divided into evaluation (with prophylactic antibiotics) and control (no antibiotic treatment) groups. Continuous variables between groups were compared using the Student’s t-test. Data were analyzed using the Chi-squared test for percentages between groups. Multivariate logistic regression was used to identify independent risk factors of SSI.


Of 1326 patients, 614 (46.3%) received prophylactic antibiotics, while 712 (53.7%) did not. There were seven (0.53%) SSIs. The SSI rate did not differ significantly between patients receiving antibiotics (0.49%, three) and those not (0.56%, four). Five patients (0.37%) had superficial infections, two (0.33%) were in the prophylactic antibiotic group and three (0.42%) were in the other group. Deep infections occurred in two patients (0.15%), one (0.16%) in the prophylactic antibiotic group and one (0.14%) in the other group. The difference between the two groups was not statistically significant (P = 1.0). Age over 50 years was associated with an increased risk of SSI (relative ratio [RR] = 1.469, 95% confidence interval [CI] 1.09–2.13, P = 0.009).


Prophylactic antibiotic use in routine knee arthroscopy without an implant may not be necessary. Age over 50 years was associated with an increased risk of SSI.


Prophylactic antibiotics Routine knee arthroscopy Surgical site infection Implant Methicillin-resistant Staphylococcus aureus 



American Society of Health-System Pharmacists


Body mass index


Confidence interval


Infectious Diseases Society of America


Methicillin-resistant Staphylococcus aureus


Relative ratio


Society for Healthcare Epidemiology of America


Surgical Infection Society


Surgical site infection

Bedeutung der antibiotischen Prophylaxe bei routinemäßiger Kniegelenksarthroskopie

Eine retrospektive Studie



Der prophylaktische Einsatz von Antibiotika vor der routinemäßigen Kniegelenksarthroskopie bleibt umstritten. Es ist wichtig zu wissen, ob Antibiotika zur Reduktion postoperativer Wundinfektionen („surgical site infections“ [SSI]) beitragen. Ziel unserer Studie war es, die Wirksamkeit der antibiotischen Prophylaxe in der SSI-Prävention zu beurteilen und Risikofaktoren für die SSI nach routinemäßiger Kniegelenksarthroskopie ohne Implantat zu identifizieren.


In einer retrospektiven Studie wurden mithilfe der elektronischen Patientenakten aus dem Krankenhaus der Autoren Patienten identifiziert, die sich zwischen Oktober 2010 und Oktober 2016 einer routinemäßigen Kniegelenksarthroskopie ohne Implantat unterzogen hatten. Demografische Daten sowie Angaben zu klinischen Eigenschaften und Antibiotikaapplikation wurden extrahiert. Arthroskopische Diagnose, Débridement, partielle oder komplette Meniskektomie, arthroskopisches Shaving und Mikrofrakturierung, Entfernung freier Gelenkkörper, Synovektomie und die laterale Retinakulumspaltung wurden eingeschlossen. Die komplexe Kniegelenksarthroskopie mit Implantat wurde ausgeschlossen. Die Patienten wurden in eine Experimental- (mit prophylaktischen Antibiotika) und eine Kontrollgruppe (ohne Antibiotikabehandlung) aufgeteilt. Kontinuierliche Variablen der Gruppen wurden mit t‑Tests verglichen. Die Daten der Gruppen wurden mit dem χ2-Test für prozentuale Anteile analysiert. Mithilfe der multivariaten logistischen Regression wurden unabhängige Risikofaktoren für SSI identifiziert.


Von 1326 Patienten erhielten 614 (46,3%) prophylaktisch Antibiotika, 712 (53,7%) erhielten diese nicht. Es gab 7 (0,53%) SSI. Die SSI-Rate unterschied sich nicht signifikant zwischen Patienten mit Antibiotika (0,49%; 3) und Patienten ohne Antibiotika (0,56%; 4). Fünf Patienten (0,37%) hatten oberflächliche Infektionen, davon waren 2 (0,33%) in der Antibiotikaprophylaxegruppe und 3 (0,42%) in der anderen Gruppe. Tiefe Infektionen ereigneten sich bei 2 Patienten (0,15%), davon eine (0,16%) in der Antibiotikaprophylaxegruppe und eine (0,14%) in der anderen Gruppe. Der Unterschied zwischen den beiden Gruppen war nicht statistisch signifikant (P = 1,0). Ein Alter über 50 Jahre war mit einem erhöhten SSI-Risiko assoziiert (relatives Risiko = 1,469; 95%-Konfidenzintervall 1,09–2,13, P = 0,009).


Der prophylaktische Einsatz von Antibiotika im Rahmen der routinemäßigen Kniegelenksarthroskopie ohne Implantat ist möglicherweise nicht notwendig. Ein Alter über 50 Jahre war mit einem erhöhten SSI-Risiko assoziiert.


Prophylaktische Antibiotika Routinemäßige Kniegelenksarthroskopie Postoperative Wundinfektionen Implantat Methicillinresistenter Staphylococcus aureus 


Compliance with ethical guidelines

Conflict of interest

Y. Qi, X. Yang, Z. Pan, H. Wang and L. Chen declare that they have no competing interests.

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Kim S, Bosque J, Meehan JP, Jamali A, Marder R (2011) Increase in outpatient knee arthroscopy in the United States: a comparison of National Surveys of Ambulatory Surgery, 1996 and 2006. J Bone Joint Surg Am 93:994–1000. CrossRefPubMedGoogle Scholar
  2. 2.
    Prokuski L, Clyburn TA, Evans RP, Moucha CS (2011) Prophylactic antibiotics in orthopaedic surgery. Instr Course Lect 60:545–555PubMedGoogle Scholar
  3. 3.
    Ruta DJ, Kadakia AR, Irwin TA (2014) What are the patterns of prophylactic postoperative oral antibiotic use after foot and ankle surgery? Clin Orthop 472:3204–3213. CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Johnson LL, Shneider DA, Austin MD, Goodman FG, Bullock JM, DeBruin JA (1982) Two per cent glutaraldehyde: a disinfectant in arthroscopy and arthroscopic surgery. J Bone Joint Surg Am 64:237–239CrossRefPubMedGoogle Scholar
  5. 5.
    McAllister DR, Parker RD, Cooper AE, Recht MP, Abate J (1999) Outcomes of postoperative septic arthritis after anterior cruciate ligament reconstruction. Am J Sports Med 27:562–570. CrossRefPubMedGoogle Scholar
  6. 6.
    Aritomi H, Yamamoto M (1979) A method of arthroscopic surgery. Clinical evaluation of synovectomy with the electric resectoscope and removal of loose bodies in the knee joint. Orthop Clin North Am 10:565–584PubMedGoogle Scholar
  7. 7.
    D’Angelo GL, Ogilvie-Harris DJ (1988) Septic arthritis following arthroscopy, with cost/benefit analysis of antibiotic prophylaxis. Arthroscopy 4:10–14CrossRefPubMedGoogle Scholar
  8. 8.
    Wieck JA, Jackson JK, O’Brien TJ, Lurate RB, Russell JM, Dorchak JD (1997) Efficacy of prophylactic antibiotics in arthroscopic surgery. Orthopedics 20:133–134PubMedGoogle Scholar
  9. 9.
    Babcock HM, Carroll C, Matava M, L’ecuyer P, Fraser V (2003) Surgical site infections after arthroscopy: outbreak investigation and case control study. Arthroscopy 19:172–181. CrossRefPubMedGoogle Scholar
  10. 10.
    Bert JM, Giannini D, Nace L (2007) Antibiotic prophylaxis for arthroscopy of the knee: is it necessary? Arthroscopy 23:4–6. CrossRefPubMedGoogle Scholar
  11. 11.
    Wyatt RWB, Maletis GB, Lyon LL, Schwalbe J, Avins AL (2017) Efficacy of prophylactic antibiotics in simple knee arthroscopy. Arthroscopy 33:157–162. CrossRefPubMedGoogle Scholar
  12. 12.
    Page CP, Bohnen JM, Fletcher JR, McManus AT, Solomkin JS, Wittmann DH (1993) Antimicrobial prophylaxis for surgical wounds. Guidelines for clinical care. Arch Surg Chic 128:79–88CrossRefGoogle Scholar
  13. 13.
    Bryson DJ, Morris DLJ, Shivji FS, Rollins KR, Snape S, Ollivere BJ (2016) Antibiotic prophylaxis in orthopaedic surgery. Bone Joint J 98–B:1014–1019. CrossRefPubMedGoogle Scholar
  14. 14.
    Kurzweil PR (2006) Antibiotic prophylaxis for arthroscopic surgery. Arthroscopy 22:452–454. CrossRefPubMedGoogle Scholar
  15. 15.
    Wyatt RWB, Maletis GB, Lyon LL, Schwalbe J, Avins AL (2016) Efficacy of prophylactic antibiotics in simple knee arthroscopy. Arthroscopy. PubMedGoogle Scholar
  16. 16.
    Tang Q, Song P, Li J, Kong F, Sun L, Xu L (2016) Control of antibiotic resistance in China must not be delayed: the current state of resistance and policy suggestions for the government, medical facilities, and patients. Biosci Trends 10:1–6. CrossRefPubMedGoogle Scholar
  17. 17.
    Hoque R, Mostafa A, Haque M (2015) Intern doctors’ views on the current and future antibiotic resistance situation of Chattagram Maa O Shishu Hospital Medical College, Bangladesh. Ther Clin Risk Manag 11:1177–1185. CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Nottingham University Hospital, Nottingham Antibiotic Guidelines Committee (2009) Surgical antibiotic prophylaxis guidelines within orthopaedic surgery for adult patientsGoogle Scholar
  19. 19.
    Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK et al (2013) Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm 70:195–283. CrossRefPubMedGoogle Scholar
  20. 20.
    Moucha CS, Clyburn T, Evans RP, Prokuski L (2011) Modifiable risk factors for surgical site infection. J Bone Joint Surg Am 93:398–404PubMedGoogle Scholar
  21. 21.
    Lee J, Singletary R, Schmader K, Anderson DJ, Bolognesi M, Kaye KS (2006) Surgical site infection in the elderly following orthopaedic surgery. Risk factors and outcomes. J Bone Joint Surg Am 88:1705–1712. CrossRefPubMedGoogle Scholar
  22. 22.
    Olsen MA, Nepple JJ, Riew KD, Lenke LG, Bridwell KH, Mayfield J et al (2008) Risk factors for surgical site infection following orthopaedic spinal operations. J Bone Joint Surg Am 90:62–69. CrossRefPubMedGoogle Scholar
  23. 23.
    Ovaska MT, Mäkinen TJ, Madanat R, Huotari K, Vahlberg T, Hirvensalo E et al (2013) Risk factors for deep surgical site infection following operative treatment of ankle fractures. J Bone Joint Surg Am 95:348–353. CrossRefPubMedGoogle Scholar
  24. 24.
    Suzuki T, Morgan SJ, Smith WR, Stahel PF, Gillani SA, Hak DJ (2010) Postoperative surgical site infection following acetabular fracture fixation. Injury 41:396–399. CrossRefPubMedGoogle Scholar
  25. 25.
    Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR (1999) Guideline for Prevention of Surgical Site Infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control 27:97–132 (quiz 133–134; discussion 96)CrossRefPubMedGoogle Scholar
  26. 26.
    Rose REC, Ameerally A, Frankson MAC, Henry H (2007) Knee Arthroscopy: surgical site infections and the need for prophylactic antibiotics. Internet J Orthop Surg 10(2):7Google Scholar
  27. 27.
    Mader JT, Wang J, Calhoun JH (2002) Antibiotic therapy for musculoskeletal infections. Instr Course Lect 51:539–551PubMedGoogle Scholar
  28. 28.
    Aujla RS, Bryson DJ, Gulihar A, Taylor GJ (2013) Trends in orthopaedic antimicrobial prophylaxis in the UK between 2005 and 2011. Ann R Coll Surg Engl 95:495–502. CrossRefPubMedGoogle Scholar
  29. 29.
    Neu HC (1984) Cephalosporin antibiotics as applied in surgery of bones and joints. Clin Orthop 190:50–64Google Scholar
  30. 30.
    Chambers HF (2001) The changing epidemiology of Staphylococcus aureus? Emerging Infect Dis 7:178–182. CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Spellberg B, Guidos R, Gilbert D, Bradley J, Boucher HW, Scheld WM et al (2008) The epidemic of antibiotic-resistant infections: a call to action for the medical community from the Infectious Diseases Society of America. Clin Infect Dis 46:155–164. CrossRefPubMedGoogle Scholar
  32. 32.
    Campbell KA, Stein S, Looze C, Bosco JA (2014) Antibiotic stewardship in orthopaedic surgery: principles and practice. J Am Acad Orthop Surg 22:772–781. CrossRefPubMedGoogle Scholar
  33. 33.
    Bandalović A, Zindović A, Boschi V, Bakota B, Marinović M, Čoklo M et al (2015) A retrospective study of antibiotic prophylaxis value in surgical treatment of lower limb fracture. Injury 46(Suppl 6):S67–S72. CrossRefPubMedGoogle Scholar
  34. 34.
    O’Connor KA, Kingston M, O’Donovan M, Cryan B, Twomey C, O’Mahony D (2004) Antibiotic prescribing policy and clostridium difficile diarrhoea. QJM 97:423–429CrossRefPubMedGoogle Scholar
  35. 35.
    Periman P (2002) Antibiotic-associated diarrhea. N Engl J Med 347:145. (author reply 145)PubMedGoogle Scholar
  36. 36.
    Treiber LA, Jones JH (2012) Medication errors, routines, and differences between perioperative and non-perioperative nurses. AORN J 96:285–294. CrossRefPubMedGoogle Scholar
  37. 37.
    Meehan J, Jamali AA, Nguyen H (2009) Prophylactic antibiotics in hip and knee arthroplasty. J Bone Joint Surg Am 91:2480–2490. CrossRefPubMedGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH 2017

Authors and Affiliations

  • Yongjian Qi
    • 1
  • Xu Yang
    • 1
  • Zhengqi Pan
    • 1
  • Hua Wang
    • 1
  • Liaobin Chen
    • 1
  1. 1.Department of Orthopaedic SurgeryZhongnan Hospital of Wuhan UniversityWuhanChina

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