Prophylactic Antibiotics Prior to Hand Surgery in Patients with Prosthetic Joints

Background: To determine the prevalence of prosthetic joint infections (PJIs) after elective clean hand surgery in order to determine whether prophylactic antibiotics are warranted in patients who have previously undergone total joint arthroplasty (TJA). Methods: All patients undergoing elective clean hand surgery between 2012 and 2018 were retrospectively cross-referenced with patients who had previously undergone a TJA at the same urban academic medical center. Inclusion criteria were any patients who underwent clean hand surgery during the study period who were an adult between the ages of 30 and 90, had a previous TJA, and did not have a previous history of a PJI. All charts were reviewed to collect data on patient demographics, co-morbidities, the type of TJA and hand surgery performed, whether prophylactic antibiotics were used prior to the hand surgery, and whether a PJI occurred within 3 months of the hand surgery. Results: Total of 331 patients (181 females and 150 males) were identified over the 6-year period that met inclusion criteria. In total, 13% of the patients received prophylactic antibiotics prior to their hand surgery and 87% had not. Only 1 case of a PJI occurred within 3 months of a hand surgery. No relationship was identified between the PJI and the hand surgery, nor the need for preoperative antibiotic prophylaxis. Conclusions: Incidence of PJI after clean hand surgery is very low. We do not recommend the routine use of antibiotic prophylaxis in patients undergoing clean elective hand surgery with a history of prior TJA in order to prophylax against a PJI.