Increasing Utilization of Extended Oral Antibiotic Prophylaxis Following Total Knee Arthroplasty From 2010 to 2022

Amy Y Zhao; Victoria E Bergstein; Amil R Agarwal; Avilash Das; Shyam Kurian; Majd Marrache; Gregory J Golladay; Savyasachi C Thakkar

doi:10.1016/j.arth.2024.11.018

Increasing Utilization of Extended Oral Antibiotic Prophylaxis Following Total Knee Arthroplasty From 2010 to 2022

J Arthroplasty. 2024 Nov 17:S0883-5403(24)01212-9. doi: 10.1016/j.arth.2024.11.018. Online ahead of print.

Authors

Amy Y Zhao¹, Victoria E Bergstein², Amil R Agarwal², Avilash Das³, Shyam Kurian², Majd Marrache², Gregory J Golladay⁴, Savyasachi C Thakkar²

Affiliations

¹ Department of Orthopaedic Surgery, The George Washington University, Washington, District of Columbia; Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland.
² Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland.
³ Department of Orthopaedic Surgery, The George Washington University, Washington, District of Columbia.
⁴ Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, Virginia.

PMID: 39551407
DOI: 10.1016/j.arth.2024.11.018

Abstract

Background: Extended oral antibiotic (EOA) prophylaxis has been shown to reduce rates of periprosthetic joint infection in high-risk patients following total knee arthroplasty (TKA). Although national societies' recommendations against their use and clinical efficacy remain controversial, the increase in the literature surrounding EOA prophylaxis suggests a potential change in practice patterns that may warrant the creation of national guidelines. The purpose of this study was to investigate the trends in the utilization of EOA prophylaxis following TKA from 2010 to 2022.

Methods: Patients who underwent primary or aseptic revision TKA between 2010 and 2022 were identified in a national administrative claims database. Temporal trends in EOA usage following primary or revision TKA were calculated, and secondary analysis examined rates of utilization across demographics, including patients considered at high risk for infection. In total, 1,258,759 primary and 91,530 aseptic revision TKA patients were included in this study.

Results: From 2010 to 2022, EOA prescriptions increased by 321 and 368% following primary and revision TKA, respectively. Rates of utilization among high-risk individuals were similar to those of the general population.

Conclusions: The use of EOA prophylaxis after TKA has increased significantly since 2010. Given their increasing usage and variation in prescription patterns among patients at high risk of infection, guidelines surrounding their use are necessary to promote antibiotic stewardship while preventing rates of infection.

Keywords: extended oral antibiotic; high risk; primary total knee arthroplasty; prophylaxis; revision total knee arthroplasty.