Post-Operative Antibiotic Prophylaxis Regimen in Total Joint Arthroplasty: Is Single Dose as Effective as Multiple Doses?

Abstract

Background: Periprosthetic joint infection (PJI) remains one of the most devastating complications following primary total joint arthroplasty (TJA). Although multiple-dose postoperative antibiotic prophylaxis is widely practiced, the role of single-dose antibiotic prophylaxis in preventing infection while minimizing antibiotic exposure remains controversial. Objective: To evaluate and compare the clinical outcomes of single-dose versus multiple-dose postoperative antibiotic prophylaxis in patients undergoing primary total knee replacement (TKR) and total hip replacement (THR). Methods: A prospective observational study was conducted between January 2023 and December 2024 at the Department of Orthopaedics, B.J. Medical College and Civil Hospital, Ahmedabad. Eighty patients undergoing primary total joint arthroplasty were included, of whom 30 received single-dose postoperative antibiotic prophylaxis and 50 received multiple-dose prophylaxis. Patients were followed for a minimum period of six months. Outcomes assessed included postoperative infection rate, readmission, adverse drug reactions, duration of hospital stay, Knee Society Score (KSS), and Harris Hip Score (HHS). Results: Both groups demonstrated comparable postoperative outcomes. The infection rate was 3.33% in the single-dose group and 4% in the multiple-dose group, with similar readmission rates (3.33% vs. 4%). The average hospital stay was 5.2 days and 5.34 days, respectively. Functional outcomes improved significantly in both groups, with comparable six-month KSS and HHS scores. No adverse drug reactions were observed in the single-dose group, whereas two patients in the multiple-dose group developed antibiotic-related complications. Conclusion: Single-dose postoperative antibiotic prophylaxis is a safe and effective alternative to multiple-dose regimens in primary total joint arthroplasty. It provides comparable infection prevention, hospital stay, and functional outcomes while reducing antibiotic exposure and the risk of antibiotic-related adverse.

Keywords:  Primary total joint arthroplasty; Total knee replacement; Total hip replacement; Antibiotic prophylaxis; Periprosthetic joint infection; Knee Society Score; Harris Hip Score.