Use of Antibiotics

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NaNaKnees

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I just have a quick question. Are antibiotics given routinely during or after TKR?

I have been put on 10 days of Doxycycline Hyclate for a cat bite. I will end it just 4 days prior to my surgery. The bite is a very small puncture wound that has pretty much healed over already, but my doctor wants me to take it as I know cat bites can be very nasty.

I just wondered if this would interfere in any way with antibiotics I may receive for my TKR.
 
With my TKR, there were some IV antibiotics given right after surgery. I don't think what you're taking now would interfere in any way, but that is something you need to discuss with your surgeon. Have you contacted him yet about the cat bite? I would call him as soon as you can.
 
Antibiotics are always given during surgery and the bone cement is antibiotic impregnated. Just make sure the doctors know about your present antibiotics and all will be well.
 
Thanks everyone. I have a call into my OS office now and am just waiting for a call back.
 
My hospital gives a routine dose of preop IV antibiotic within an hour of the incision. I think they may give another dose later that day.

Donna
 
This is a recent paper from Canada comparing cement with antibiotic and without:

Study: Antibiotic cement use for TKR does not impact 2-year revision rates
  • Orthopedics Today, July 2012
Use of antibiotic-coated bone cement during primary total knee replacement does not reduce the risk of early revision, according to recently presented findings by Canadian researchers.
“It appears the addition of antibiotics to cement for primary [total knee replacement] TKR in osteoarthritis has no clinically important effect on the risk of revision within 2 years of surgery,” study investigator Eric R. Bohm, MD, said. “Longer follow-up, as well as confirmation of these findings in other national registries, is warranted.”
Bohm presented the findings at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting.
Cemented primary replacements
Bohm and colleagues used the Canadian Joint Replacement Registry to identify 36,681 patients with degenerative arthritis who had a cemented primary TKR and stratified the cohort to determine those revised within 2 years and the reasons for revision. The investigators noted whether antibiotics in the cement were used, as well as patients’ age, gender and comorbidities.
“We used a primary outcome metric of revision within 2 years for any reason because aseptic loosening and infection account for about 30% of early and 60% of late revisions in the Canadian Joint Replacement Registry,” Bohm said. “We also think it captures unanticipated negative consequences of using antibiotic-loaded bone cement. We felt that antimicrobial activity would be minimal by 2 years.”
Of the 36,681 patients, 16,665 patients had antibiotics added to their cement. Overall, there were 532 revisions (1.45%) during the 2-year period — 1.51% in the antibiotic cemented group and 1.4% in the non-antibiotic cemented group.
Cost-effectiveness
Bohm also looked at the cost-effectiveness of antibiotic cement. His group found that the revision rate of the antibiotic cemented group would need to reach 0.9% for the use of antibiotic bone cement to be cost-effective.
“The use of antibiotic-loaded bone cement does not change the 2-year revision risk,” Bohm said. “It does not appear to be cost-effective either.”
He noted that further revision data available for 206 of the 532 revision patients revealed that the non-antibiotic cemented group had twice as many aseptic loosening-related revisions as the antibiotic cemented group. However, they found no differences between the groups for rates of infection-related revision and pain of unknown origin. – by Robert Press
Reference:
  • Bohm ER, Gu J, Zhu N, et al. The addition of antibiotics to cement does not appear to lower the risk of early revision in knee replacement surgery. Paper #133. Presented at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting. Feb. 7-11. San Francisco.
 
antibiotic-coated bone cement
That's a bit curious - bone cement is impregnated with antibiotics, not coated. :scratch:
 
Interesting, haven't noticed the use of coated before. However, the PMMA molecule may well be coated during the preparation of the substance.
:spin:
 
Well, I would prefer to have a good coat if I was about to be stuck in a warm wet sticky environment. Wouldn't you?:flwrysmile:
 
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