Antibiotic Prophylaxis in Total Joint Arthroplasty

Periprosthetic joint infection (PJI) is a severe complication following total knee arthroplasty (TKA) and total hip arthroplasty (THA), associated with significantly increased patient morbidity and mortality. PJI remains the leading cause of early revision surgery after total joint arthroplasty and imposes a substantial financial burden on the healthcare system. In the United States, the incidence of PJI is estimated at 1–2% for primary THA and TKA procedures. Infections can arise from local spread from the skin or air, or through hematogenous seeding of the affected joint. Reducing the bacterial load at the surgical site is critical for preventing postoperative infections, and this goal is achieved through rigorous maintenance of perioperative sterility and appropriate antibiotic administration. Antibiotic prophylaxis is a cornerstone of infection prevention in arthroplasty and has been conclusively shown to lower the incidence of PJI. However, considerable variability and ongoing debate exist regarding the optimal route of antibiotic administration for infection prevention in THA and TKA. This review summarizes the current evidence on antibiotic strategies during primary total hip and knee arthroplasty, with the aim of informing perioperative management decisions among arthroplasty specialists and other clinicians involved in the care of these patients. This review will help guide perioperative decisions for arthroplasty specialists and will also serve as a valuable resource for general practitioners and infectious disease specialists who are involved in the care of patients who are about to undergo or have previously undergone a total joint arthroplasty procedure. This article is well-suited for publication in BMC Musculoskeletal Disorders because it addresses a major cause of morbidity and revision surgery in orthopaedic practice, aligning closely with the journal’s focus on musculoskeletal health and disease. By synthesizing current evidence on antibiotic prophylaxis in total joint arthroplasty, it offers practical guidance for clinicians, researchers, and policymakers seeking to improve surgical outcomes. The article’s multidisciplinary relevance, spanning orthopaedics, infectious disease, and perioperative care, fits the journal’s commitment to publishing research that bridges clinical practice and broader healthcare impacts.