Extended oral antibiotic prophylaxis and PJI-free survivorship after primary total knee arthroplasty

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee Pub Date : 2025-05-17 DOI:10.1016/j.knee.2025.04.005

Andrew A. Fuqua , Jacob A. Worden , Ayomide M. Ayeni , Kyle E. Bundschuh , Ajay Premkumar , Jacob M. Wilson

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引用次数: 0

Abstract

Introduction

Recent evidence has emerged supporting the use of extended oral antibiotic (EOA) prophylaxis after primary total knee replacement (TKA) to reduce periprosthetic joint infection (PJI) in high-risk patients. However, much of the evidence stems from single-institution series with limited sample sizes. This study aimed to explore the impact of EOA on complications and infection-free survivorship in a large cohort of patients after primary TKA.

Methods

A large national database was used to identify patients undergoing primary TKA from 2015 to 2022. Patients receiving 7–14 days of EOA were identified. Propensity-score matching, based on patient comorbidities, was used to match patients who received EOA and to control patients who did not. Three cohorts were created: any-risk, high-risk, and standard-risk. Complications at 90-days were assessed with univariate analysis and survivorship free of PJI to 2 years was analyzed with the Kaplan-Meier method and cox regression.

Results

We identified 5,701 patients who received EOA: 3,628 (64%) with high-risk comorbidities and 2,073 (36%) standard risk. There were no significant reduction in hazard of PJI at 90-days (any-risk: HR: 1.65, 95% CI: 0.90–3.04, P = 0.11; high-risk: HR: 1.37, 95% CI: 0.69–2.70, P = 0.4; standard-risk: HR: 1.51, 95% CI: 0.53–4.26, P = 0.4), 1 year (P > 0.07), or 2 years (any-risk: HR: 1.42, 95% CI: 0.98–2.05, P = 0.065; high-risk: HR: 1.14, 95% CI: 0.76–1.73, P = 0.5; standard-risk: HR: 1.51, 95% CI: 0.76–2.98, P = 0.2) with EOA administration.

Discussion

EOA prophylaxis was not associated with improved PJI-free survivorship at any measured time point following primary TKA in either high-risk or standard-risk risk patients. Given the observed widespread use of EOA, our study highlights the need for further investigation to delineate what specific populations may benefit from EOA prophylaxis.

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原发性全膝关节置换术后延长口服抗生素预防和无pji生存

最近有证据支持原发性全膝关节置换术（TKA）后使用延长口服抗生素（EOA）预防，以减少高危患者假体周围关节感染（PJI）。然而，大部分证据来自单一机构的系列研究，样本量有限。本研究旨在探讨EOA对原发性TKA后患者并发症和无感染生存的影响。方法使用大型国家数据库识别2015年至2022年进行原发性TKA的患者。确定接受7-14天EOA治疗的患者。基于患者合并症的倾向评分匹配用于匹配接受EOA的患者和未接受EOA的患者。创建了三个队列：任意风险、高风险和标准风险。用单因素分析评估90天的并发症，用Kaplan-Meier法和cox回归分析无PJI至2年的生存率。结果我们确定了5701例接受EOA的患者：3628例（64%）有高危合并症，2073例（36%）有标准风险。在第90天PJI的危险没有显著降低(任何风险：HR: 1.65, 95% CI: 0.90-3.04, P = 0.11；高危：HR: 1.37, 95% CI: 0.69 ~ 2.70, P = 0.4；标准危险:人力资源:1.51,95%置信区间CI: 0.53 - -4.26, P = 0.4), 1年(P比;0.07),或2年以上(任何风险:人力资源:1.42,95%置信区间CI: 0.98 - -2.05, P = 0.065;高危：HR: 1.14, 95% CI: 0.76-1.73, P = 0.5；标准风险：HR: 1.51, 95% CI: 0.76-2.98, P = 0.2)。讨论：在高危或标准风险患者的原发性TKA后的任何测量时间点，oa预防与改善无pji生存无关。鉴于观察到EOA的广泛使用，我们的研究强调需要进一步调查，以确定哪些特定人群可能从EOA预防中受益。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Knee 医学-外科

CiteScore

3.80

自引率

5.30%

发文量

171

审稿时长

6 months

期刊介绍： The Knee is an international journal publishing studies on the clinical treatment and fundamental biomechanical characteristics of this joint. The aim of the journal is to provide a vehicle relevant to surgeons, biomedical engineers, imaging specialists, materials scientists, rehabilitation personnel and all those with an interest in the knee. The topics covered include, but are not limited to: • Anatomy, physiology, morphology and biochemistry; • Biomechanical studies; • Advances in the development of prosthetic, orthotic and augmentation devices; • Imaging and diagnostic techniques; • Pathology; • Trauma; • Surgery; • Rehabilitation.