Extended antibiotic prophylaxis in primary total knee arthroplasty: A narrative review of current evidence and controversies

Table 2 Systematic reviews and meta-analyses evaluating prophylaxis duration in primary hip and knee arthroplasty (2000-2025)

Ref.	Scope and database	Arthroplasty types covered	Studies/patients included	Prophylaxis strategies compared	Infection outcome (PJI/SSI)	Certainty of evidence and key limitations
Siddiqi et al[20]	Systematic review and meta-analysis of total joint arthroplasty literature	TKA and THA	Multiple RCTs and observational studies; specific n per protocol in paper	Prolonged prophylaxis vs shorter protocols (varied definitions across included studies)	No reduction in SSI or PJI beyond initial dosing; certainty limited by low event rates	Low-certainty; heterogeneous protocols and eras; underpowered RCTs; rare-event bias; variable reporting of harms
Fernandes et al[19]	Systematic review and meta-analysis of primary hip and knee arthroplasty literature	TKA and THA	Nearly 300000 TKAs as stated in manuscript	Single-dose vs extended prophylaxis (definition of extended varies across included cohorts)	Lower PJI odds with single-dose vs extended (reported odds ratio = 0.78; 95%CI: 0.63-0.98); SSI trend favoured single-dose but did not reach significance	Meta-analysis inherits confounding from observational studies; definition of extended differs across cohorts; harms and resistance variably captured across included studies

PJI: Periprosthetic joint infection; RCT: Randomised controlled trial; SSI: Surgical site infection; TKA: Total knee arthroplasty; THA: Total hip arthroplasty.