Antibiotic prophylaxis for arthroscopy of the knee: Is it necessary?

Bert JM, Giannini D, Nace L.
Arthroscopy: The Journal of Arthroscopic and Related Surgery, 2007; 23:4-6.

Knee arthroscopy is the most commonly performed orthopaedic procedure in Europe and North America. Routine prophylactic antibiotic administration before arthroscopy is an important and controversial clinical issue. The authors have retrospectively compared the incidence of infection after routine arthroscopic meniscectomy of the knee with and without preoperative prophylactic intravenous antibiotics.

2,780 patients who had an arthroscopic meniscectomy over a period of 3 years were included in the study. The mean age was 43 years and 61% were male patients. The procedures were performed by 6 orthopaedic surgeons. 97% were done under local intra-articular anaesthetic injection. The knees were prepared by povidone iodine before intra-articular injection of local anaesthetic. The mean surgical time was 24 minutes and none exceeded 41 minutes. 933 (34%) patients had prophylactic antibiotics and 1847 (66%) did not. 1gm of cefazolin was administered intravenously within 1 hour before surgery in all patients without an allergy to penicillin. 1gm of vancomycin was administered in patients with penicillin allergy.

There was no statistical difference in infection rates between the knee arthroscopy patients who had prophylactic antibiotics and those who did not. Infection was strictly defined present only in those with clinical signs and symptoms of a septic joint with a positive joint aspirate. The infection rate was 0.15% in patients who received prophylactic antibiotics and 0.16% in patients who did not receive prophylaxis. All infections were due to Staphylococcus aureus. None of these patients had associated significant medical illnesses such as diabetes mellitus, cancer or cardiopulmonary disease.

This study concludes that there is no value in administering prophylactic antibiotics before routine arthroscopic knee procedures to prevent joint sepsis. Retrospective design (level III evidence) is a drawback of this study as it introduces bias and further prospective studies are required.


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