The use of preventive antibiotics in orthopaedic surgery

The use of preventive antibiotic therapy in patients with femoral neck fractures and those treated by prosthetic joint arthroplasty is an accepted practice, yet it remains controversial in other clean orthopedic surgical procedures. The devastating consequences of prosthetic joint infection are the major rationale for antibiotic prophylaxis. Recent data indicate that some of the unfavorable effects of antibiotic prophylaxis, such as the expense and drug-related side effects, can be limited by restricting the duration of antibiotic use. The critical importance of instituting antibiotic therapy immediately prior to surgery is emphasized. The authors currently favor, for most clean, elective orthopedic surgeries, two grams of cefazolin administered intravenously immediately prior to surgery and one gram every eight hours for 24 hours after surgery. This view is reinforced by comparing the incidence of infection in 1341 total joint arthroplasties (0.6% infection rate) receiving three days of antibiotic prophylaxis and 450 cases (0.6% infection rate) receiving one day of antibiotic prophylaxis. Patients with prosthetic joints should be instructed regarding the possibility of late infections and encouraged to take antibiotic prophylaxis for various surgical procedures. Patients are further urged to notify their orthopedist in the event that any significant infectious process is present.