Systematic Review
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Nov 18, 2018; 9(11): 262-270
Published online Nov 18, 2018. doi: 10.5312/wjo.v9.i11.262
Should antibiotics be administered before arthroscopic knee surgery? A systematic review of the literature
John Carney, Nathanael Heckmann, Erik N Mayer, Ram K Alluri, Carleton Thomas Vangsness Jr., George F Hatch III, Alexander E Weber
John Carney, Nathanael Heckmann, Erik N Mayer, Ram K Alluri, Carleton Thomas Vangsness Jr., George F Hatch III, Alexander E Weber, Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA 90033, United States
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: No potential conflicts of interest. No financial support.
PRISMA 2009 Checklist statement: The guidelines of the PRISMA 2009 Statement have been adopted.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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:
Correspondence to: Alexander E Weber, MD, Assistant Professor, Department of Orthopaedic Surgery, University of Southern California, 1520 San Pablo Street, Suite 2000, Los Angeles, CA 90033, United States.
Telephone: +1-818-9497381
Received: July 2, 2018
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
Research background

The administration of prophylactis antibiotics prior to knee arthroscopy is a common practice in the orthopaedic community.

Research motivation

There are no studies to date that demonstrate that the use of antibiotic prophylaxis in arthroscopic surgery of the knee is effective.

Research objectives

The purpose of this study is to analyze the literature on the effect on antibioitic prophylaxis in knee arthroscopy on rates of septic arthritis.

Research methods

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.

Research results

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).

Research conclusions

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.

Research perspectives

Further prospective studies on this topic will help further elucidate this conclusion.