Should antibiotics be administered before arthroscopic knee surgery? A systematic review of the literature

Table 1 Summary of literature review results

Study name	Study type	No. of Patients	Procedures done	Findings/results/conclusions
Wyatt et al[8]	Retrospective Review	40810	Diagnostic arthroscopy, joint debridement, synovectomy, partial or complete meniscectomy, meniscus repair, microfracture, and lateral retinacular release	No significant difference in infection rates between prophylaxis and non-prophylaxis groups
Bert et al[7]	Retrospective Review	3231	Arthroscopic meniscectomy, arthroscopic meniscal repair, loose body removal, lateral retinacular release, and arthroscopic debridement	No significant difference in infection rates between prophylaxis and non-prophylaxis groups
Qi et al[17]	Retrospective Review	1326	Arthroscopic diagnosis, debridement, partial or complete meniscectomy, arthroscopic shaving and microfracture, removal of loose bodies, synovectomy and lateral retinacular release	No significant difference in infection rates between prophylaxis and non-prophylaxis groups
Ghnmait et al[15]	Randomized control trial	180	Diagnostic arthroscopy, meniscus repair	No significant difference in infection rates between prophylaxis and non-prophylaxis groups
Rose et al[12]	Retrospective Review	302	Meniscectomies, arthroscopic debridement, arthroscopic meniscal repair, arthroscopic shaving and microfracture, removal of loose bodies, arthroscopic synovectomy, arthroscopic lateral retinacular release and diagnostic arthroscopic	No significant difference in infection rates between prophylaxis and non-prophylaxis groups
Wieck et al[16]	Randomized control trial	437	Unspecified arthroscopy	No significant difference in infection rates between prophylaxis and non-prophylaxis groups
Phegan et al[18]	Retrospective Review	1585	ACL reconstruction with graft	Vancomycin soaked grafts have a lower infection rate than non-soaked grafts
Vertullo et al[19]	Retrospective Review	1135	ACL reconstruction with graft	Vancomycin soaked grafts have a lower infection rate than non-soaked grafts
Pérez-Prieto et al[22]	Retrospective Review	1544	ACL reconstruction with graft	Vancomycin soaked grafts have a lower infection rate than non-soaked grafts
Yazdi et al[31]	Randomized control trial	360	ACL reconstruction with graft	Using gentamicin in irrigating solutions during arthroscopic ACL reconstruction surgery does not statistically decrease post-operation septic arthritis
Formaini et al[10]	Retrospective Review	2330	Unspecified arthroscopy	No significant difference in infection rates between prophylaxis and non-prophylaxis groups
Armstrong et al[11]	Retrospective Review	4256	Unspecified arthroscopy	Infection following knee arthroscopy was associated with prolonged operation time and corticosteroid use, not presence or absence of prophylactic antibiotics
D'Angelo and Ogilvie-Harris[26]	Retrospective Review	9	Unspecified arthroscopy	Antibiotic prophylaxis may reduce hospital costs by reducing spending on treating septic arthritis based on a 9 case review of patients with septic arthritis following arthroscopy
Babcock et al[23]	Retrospective Review	27	Unspecified arthroscopy	In a case series review of septic arthitis patients, shaving and corticosteriods were found to be significant risk factors, but not antibiotics
Lubowitz et al[25]	Review Article	NA	NA	There is not enough evidence to conclude whether or not antibiotics should be administered prophylactically in knee arthroscopy. However, the results of articles like Bert et al should be further examined and studied
Kurzweill[27]	Review Article	NA	NA	There is not enough evidence to conclude whether or not antibiotics should be administered prophylactically in knee arthroscopy. However, they should still be used as a measure to reduce the risk of post procedure infection
Onyema et al[24]	Review Article	NA	NA	Prophylactic antibiotics should not be used for knee arthroscopy
Prokuski[6]	Review Article	NA	NA	Cephalosporins are the drug of choice for most orthopedic surgeries. However, there is a lack of evidence supporting their efficacy in arthroscopic surgery
Müller-Rath et al [9]	Survey	110 physicians	NA	62 % of the surgeons reported the use of an antibiotic prophylaxis in every arthroscopic case, while 19 % administer antibiotics only occasionally
Mini et al [13]	Survey	166 hospitals	NA	57.1% of orthopedic surgeons routinely use antibiotic prophylaxis for arthroscopy

ACL: Anterior cruciate ligament; NA: Not available.

Table 2 Comparison of infection rates in simple arthroscopy patients receiving prophylactic antibiotics

Study name	Total patients	Patients receiving antibiotics	Patients not receiving antibiotics	No. of septic arthritis cases: Antibiotic group	No. of septic arthritis cases: No antibiotic group	Septic arthritis: Antibiotic group (%)	Septic arthritis rate: No antibiotic group (%)	P valuea
Wyatt et al[8]	40810	32836	7974	25	11	0.08	0.14
Bert et al[7]	2780	933	1847	1	3	0.15	0.16
Qi et al[17]	1326	614	712	1	1	0.16	0.14
Ghnmait et al[15]	180	90	90	0	0	0	0
Rose et al[12]	302	14	288	0	1	0	0.35
Total	45398	34487	10911	27	16	0.08	0.15	0.05

Table 3 Comparison of infection rates in simple arthroscopy patients receiving prophylactic antibiotics, excluding bony procedures

Study name	Total patients	Patients receiving antibiotics	Patients not receiving antibiotics	No. of septic arthritis cases: Antibiotic group	No. of septic arthritis cases: No antibiotic group	Septic arthritis rate: Antibiotic group (%)	Septic arthritis rate: No antibiotic group (%)	P valuea
Bert et al[7]	2780	933	1847	1	3	0.11	0.16
Ghnmait et al[15]	180	90	90	0	0	0	0
Total	2960	1023	1937	1	3	0.1	0.15	0.69

Table 4 Comparison of infection rates in arthroscopic anterior cruciate ligament reconstruction with vs without vancomycin graft soaking

Study name	Total patients	IV prophylaxis alone	IV prophylaxis + vancomycin	Number infected IV alone	Number infected IV + vancomycin	Infection rate IV alone (%)	Infection rate IV + vancomycin (%)	P valuea
Phegan et al[18]	1585	285	1300	4	0	1.4	0
Pérez-Prieto et al[22]	1544	810	734	15	0	1.85	0
Total	3129	1095	2034	19	0	1.74	0	< 0.001