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Prophylactic oral antibiotics reduce reinfection rates following two-stage revision total knee arthroplasty

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Abstract

The purpose of this study was to compare the incidence of reinfection in patients who received oral antibiotic prophylaxis with those who did not following two-stage revision knee arthroplasty. Additional purposes included: (1) comparison of these findings to the infection rate in patients who underwent revision for aseptic reasons, and (2) characterisation of the organisms responsible for reinfection following revision procedures. Twenty-eight two-stage revision knee arthroplasty procedures were followed up by a mean of 33 days of oral antibiotics (range, 28–43 days), while the remaining 38 procedures received only 24–72 hours of in-patient antibiotics. The incidence of reinfection in each group within 12 months was compared. The reinfection rates were additionally compared to those of 237 patients who underwent revision for aseptic loosening over the same time period. Patients who were treated with postoperative antibiotic prophylaxis had a considerably lower reinfection rate, with one reinfection in the prophylaxis group (4%), compared to six reinfections in the no-prophylaxis group (16%). The reinfection rates remained higher compared to those found in patients who underwent revision knee arthroplasty for aseptic loosening (1 of 237 patients; 0.4%). Both high and low virulence organisms were identified in the patients who were subsequently reinfected. A minimum of 28 days of postoperative oral antibiotics appeared to decrease reinfection rates following two-stage revision knee arthroplasty. These results suggest that the use of oral antibiotic prophylaxis following re-implantation may be appropriate in all patients undergoing two-stage revision, even in the absence of any signs of active infection.

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Conflict of interest

No external funding was provided in support of this study. The authors certify that they have full control of all primary data and agree to allow the journal to review the data if requested.

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  1. Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA

    Michael G. Zywiel, Aaron J. Johnson, D. Alex Stroh, Jabari Martin, David R. Marker & Michael A. Mont

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  1. Michael G. Zywiel
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  2. Aaron J. Johnson
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  3. D. Alex Stroh
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  4. Jabari Martin
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  5. David R. Marker
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  6. Michael A. Mont
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Correspondence to Michael A. Mont.

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Zywiel, M.G., Johnson, A.J., Stroh, D.A. et al. Prophylactic oral antibiotics reduce reinfection rates following two-stage revision total knee arthroplasty. International Orthopaedics (SICOT) 35, 37–42 (2011). https://doi.org/10.1007/s00264-010-0992-x

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  • DOI: https://doi.org/10.1007/s00264-010-0992-x

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