Optimal Timing and Antibiotic Prophylaxis in Periprosthetic Joint Infection: Literature Review and World Consensus (Part Four)

Context: There is a need to find the optimal postoperative duration and the choice of starting antibiotics for cases who presumed infected or at the time of second stage exchange arthroplasty in two-stage revision of infected cases. Evidence Acquisition: Delegates in workgroup 3 of the consensus meeting on PJI reviewed English literature for relevant articles. Sixty-two of 221 articles were relevant to the 5 following questions regarding perioperative antibiotic prophylaxis to prevent periprosthetic joint infection. Results: Postoperative antibiotics should not be administered for greater than 24 hours after surgery. In a patient with a presumed infection when culture results are pending, empiric antibiotic coverage should depend on the local microbiological epidemiology. Culture data should assist in the tailoring of antibiotic regimens. The appropriate preoperative antibiotic for the second stage should include coverage of the prior organism (s). Cemented arthroplasty components should be inserted with antibiotic-laden bone cement (strong consensus). Conclusions: Recommendations for choice, duration of perioperative antibiotic prophylaxis in hip and knee arthroplasty were provided based on evidences in the literature and consensus of expert delegates from consensus meeting.