Antibiotic prophylaxis in total joint arthroplasty - The usual practice and variability among joint replacement surgeons in Hong Kong

Abstract

In the current ageing population, the incidence of osteoarthritis and total joint arthroplasties is increasing each year. One rare but devastating complication after arthroplasty is periprosthetic joint infection (PJI), which may expose the patient to repeated operation subsequently and impose a high financial cost to the healthcare system. Joint replacement surgeons have been undertaking various measures to prevent PJI. One of the most well-established measures is to prescribe perioperative intravenous antibiotic as a prophylaxis to PJI. This has led to the creation of numeral guidelines published by different institutions around the world. However, many of these guidelines did not include specifics of the prescription, such as the choice of antibiotics, how the surgeon should proceed when patient has documented allergy, whether the dose given should be weight-adjusted, whether a combination of antibiotics is beneficial, and whether giving additional doses after the operation can reduce the risk of PJI. Without specific recommendations from guidelines, the usual practice might vary widely from surgeon to surgeon. We conducted an online survey of practising orthopaedic surgeons in Hong Kong. Questions comprise the usual choice of antibiotics, the usual dose of antibiotics, their approach when patients have documented antibiotic allergy, their adjustments for overweight patients, and regarding additional doses after the operation. The purpose of this study is to investigate and compare the usual practice and variability of prescribing antibiotic prophylaxis among different joint replacement surgeons in Hong Kong.