Published online Nov 18, 2018. doi: 10.5312/wjo.v9.i11.262
Peer-review started: July 2, 2018
First decision: July 18, 2018
Revised: September 9, 2018
Accepted: October 23, 2018
Article in press: October 23, 2018
Published online: November 18, 2018
The administration of prophylactis antibiotics prior to knee arthroscopy is a common practice in the orthopaedic community.
There are no studies to date that demonstrate that the use of antibiotic prophylaxis in arthroscopic surgery of the knee is effective.
The purpose of this study is to analyze the literature on the effect on antibioitic prophylaxis in knee arthroscopy on rates of septic arthritis.
We conducted a literature review of PubMed, MEDLINE, and Web of Science from inception to May of 2018. Data from studies meeting inclusion criteria were pooled for analysis. Risk-ratios were calculated to determine the effect of antibiotic prophylaxis on rates of septic arthritis in knee arthroscopy.
Nineteen studies met inclusion critera for pooled analysis. For those not undergoing graft procedures, there were 27 cases of post-operative septic arthritis in 34487 patients (0.08%) who received prophylactic antibiotics and 16 cases in 10911 (0.15%) who received none [risk ratio (RR) = 0.53, 95% confidence interval (CI): 0.29-0.99, P = 0.05]. A sub-group analysis in which bony procedures were excluded was performed which found no significant difference in infection rates between patients that received prophylactic antibiotics and patients that did not (P > 0.05). All ACL reconstruction studies used prophylactic antibiotics, but two studies investigating the effect of soaking the graft in vancomycin in addition to standard intravenous (IV) prophylaxis were combined for analysis. There were 19 cases in 1095 patients (1.74%) who received IV antibioitics alone and no infections in 2,034 patients who received IV antibiotics and had a vancomycin soaked graft (RR = 0.01, 95%CI: 0.001-0.229, P < 0.01).
Our study is the first to demonstrate prophylactic antibiotics are effective in preventing septic arthritis following simple arthroscopic procedures of the knee, though given the large number needed to treat, the clinical significance of this finding is unclear. Our literature search demonstrates that there is little to no debate that antibiotics should be used prophylactically for arthroscopic surgeries involving graft implantation. However, our findings indicate that the addition of graft soaking further reduces the rate of infection.
Further prospective studies on this topic will help further elucidate this conclusion.