International Journal of Clinical & Medical Surgery
ISSN: 3069-2067 | DOI: 10.64030/3069-2067
Andrzej Brzezinski, Michael Simon, Rajiv S. Vasudevan, Krzysztof Scharoch, Dariusz Marczak, Maciej Grzelak, Piotr Dudek and Stephan Kayiaros
Periprosthetic joint infection (PJI) following total hip or knee arthroplasty is a serious complication that contributes to early revision surgery, increased morbidity, and elevated healthcare costs. This review evaluates current evidence on antibiotic strategies for PJI preven-tion, focusing on perioperative prophylaxis. Intravenous cefazolin, administered within one hour before incision, remains the gold standard due to its broad-spectrum activity and safety profile, including in many patients with reported penicillin allergies. Alternatives such as ce-furoxime and vancomycin are considered in specific cases, though vancomycin monotherapy is less effective and carries higher risks. Dual antibiotic prophylaxis, particularly adding vancomy-cin in MRSA-colonized or high-risk patients, has not consistently shown benefit in broader pop-ulations. Local delivery methods such as intraosseous regional antibiotics (IORA) and vancomy-cin powder have shown promise in increasing tissue concentrations but lack definitive clinical benefit, with concerns about complications. Similarly, extended oral antibiotic prophylaxis postoperatively
may reduce PJI risk in high-risk populations, though evidence remains mixed. The article concludes by recommending weightbased cefazolin as standard prophylaxis, dual therapy for high-risk individuals, and further research to clarify the role of adjunctive and local delivery methods in PJI prevention