Prospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Feb 18, 2024; 15(2): 170-179
Published online Feb 18, 2024. doi: 10.5312/wjo.v15.i2.170
Assessment of the effectiveness of weight-adjusted antibiotic administration, for reduced duration, in surgical prophylaxis of primary hip and knee arthroplasty
Tosan Okoro, Michael Wan, Takura Darlington Mukabeta, Ella Malev, Marketa Gross, Claudia Williams, Muhammad Manjra, Jan Herman Kuiper, John Murnaghan
Tosan Okoro, Department of Arthroplasty, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry SY10 7AG, United Kingdom
Tosan Okoro, School of Medicine, Keele University, Staffordshire ST5 5BG, United Kingdom
Michael Wan, St Joseph’s Health Centre, Unity Health Toronto, Toronto M6R 1B5, Canada
Takura Darlington Mukabeta, Department of Arthroplasty, The Royal London Hospital, Barts Health NHS Trust, London E1 1BB, United Kingdom
Ella Malev, Marketa Gross, Claudia Williams, Muhammad Manjra, John Murnaghan, Department of Arthroplasty, Sunnybrook Holland Orthopaedic and Arthritis Centre, Toronto M4Y 1H1, Canada
Jan Herman Kuiper, Institute for Science and Technology in Medicine, Keele University, Staffordshire ST5 1BG, United Kingdom
Author contributions: Okoro T, Murnaghan J designed the research study; Okoro T, Wan M, Mukabeta TD, Williams C, Malev E, Manjra M, Gross M performed the research; Okoro T, Kuiper JH performed the statistical analysis; Okoro T, Kuiper JH, Murnaghan J analyzed the data and wrote the manuscript; All authors have read and approve the final manuscript.
Institutional review board statement: This study was approved by the Sunnybrook Health Sciences Centre, Toronto, Research Ethics Board in September 2018.
Clinical trial registration statement: The clinical trial is registered with, using identifier NCT00526890. Details can be found at
Informed consent statement: I wish to confirm that the above study was performed after approval as a quality improvement project by the Sunnybrook Health Sciences Research Department without the need for formal ethics committee approval and therefore did not require informed consent from the patients.
Conflict-of-interest statement: All the authors have no conflict of interest to declare.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Tosan Okoro, BSc, MBChB, PhD, FRCS, Consultant Trauma and Orthopaedic Surgeon, Honorary Senior Clinical Lecturer, Department of Arthroplasty, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Gobowen, Oswestry SY10 7AG, United Kingdom.
Received: November 8, 2023
Peer-review started: November 8, 2023
First decision: November 29, 2023
Revised: December 8, 2023
Accepted: January 5, 2024
Article in press: January 5, 2024
Published online: February 18, 2024
Research background

Antibiotic stewardship is important in everyday orthopaedic practice. Preventing surgical site infection (SSIs) with the use of prophylactic antibiotics has to take into account the impact of obesity. There is a growing consensus that a weight based regime may be efficacious in dealing with SSIs in everyday practice.

Research motivation

This study aimed to evaluate the impact of a weight based regime administered for a shorter duration, on the incidence of SSIs in a cohort of patients undergoing elective primary total hip and knee arthroplasty (THA/TKA).

Research objectives

The main objective of the study was to evaluate if there was no reduction in levels of prophylaxis for a weight based antibiotic regime, administered for a shorter duration, vs a standard regime in prevention of SSIs in a cohort of patients undergoing elective primary THA/TKA.

Research methods

A cohort of arthroplasty patients undergoing primary THA/TKA with a single pre-operative dose and two post-operative antibiotic doses (old regime, OR; September to December 2018), was compared to a group of patients undergoing primary THA/TKA after the regime had been changed to a weight-adjusted pre-operative dose and a single post-operative dose [new regime, (NR); January to April 2019]. Our hypothesis was that the introduction of a weight-adjusted regime of shorter duration in the NR would not lead to a change in the incidence of all SSI when compared to the old regime (OR).

Research results

The findings from this study are in agreement with our null hypothesis that using a weight based antibiotic prophylaxis regime and shortening the duration of administered antibiotics, would not lead to a statistically significant increase in deep incisional/organ space SSI rates between the OR and NR groups. The use of a weight-adjusted regime led to a reduction in the rates of superficial SSIs [NR (1.67%) vs OR (2.07%)] but this was not found to be statistically significant.

Research conclusions

It is important to consider use of a weight based regime for a shorter duration in patients undergoing elective primary THA/TKA as there is no increased SSI risk.

Research perspectives

More studies on antibiotic prophylaxis stewardship for this group of patients is required.