Keywords
1. Total Hip Arthroplasty
2. Extended Oral Antibiotics
3. Prosthetic Joint Infection
4. Antibiotic Stewardship
5. Orthopedic Surgery
New research published in The Journal of Arthroplasty has revealed significant increases in the practice of prescribing extended oral antibiotic (EOA) prophylaxis after primary and revision total hip arthroplasty (THA) procedures. The study, which ran from 2010 to 2022, tracked the administration of postoperative antibiotics to 646,059 primary THA patients and 51,879 undergoing aseptic revision THA.
The study, led by Amy Y. Zhao of the Department of Orthopaedic Surgery at The George Washington University, not only showcases a growing trend in EOA usage but also raises questions about the lack of standardized national guidelines which, experts argue, could harmonize practices and promote better antibiotic stewardship in the field of orthopedic surgery.
Surge in Prophylactic Antibiotic Use Post Hip Arthroplasty
The extensive body of data collected by Zhao and colleagues over a 12-year period details a significant uptick in EOAs after hip replacement surgeries. For those undergoing primary THA, the administration of these drugs increased by a staggering 366 percent, while for patients who had revision THA, the increase was 298 percent.
Interestingly, the study, which was conducted using a national administrative claims database, found that of patients prescribed postoperative antibiotics, 30 percent and 59 percent of those undergoing primary and revision THA, respectively, were given an antibiotic regimen spanning more than seven days.
Lack of Consensus Calls for National Guidelines
One of the key findings from Zhao’s research is the wide variation in prescription patterns. While this versatility points to a personalized approach to patient care, it also underscores an urgent need for unified standards. The stark increase in antibiotic use seems to be a responsive measure to the threat of prosthetic joint infection (PJI), a serious complication that can arise after hip replacements. Yet, despite good intentions, this rise hints at a broader, more indiscriminate use of antibiotics across patient demographics.
According to the study’s authors, “as current trends demonstrate a wide variation in prescription patterns, including in length of antibiotic duration and in patient population prescribed, guidelines surrounding the use of EOA prophylaxis after THA are necessary to promote antibiotic stewardship while preventing rates of PJI.”
Balancing Infection Risks and the Rise of Antibiotic Resistance
The increased use of antibiotics in the orthopedic field corresponds with growing concerns around the world regarding the potential for antibiotic resistance – an outcome of overprescribing antibiotics. The study acknowledges the delicate balance that needs to be struck between using EOAs to prevent serious infections in patients, particularly those at high risk, and preventing the spread of antibiotic-resistant bacteria.
The nuanced approach needed in navigating this healthcare challenge is not yet reflected in a unified, national strategy. Experts point out that a clear set of guidelines could aid orthopedic surgeons in making informed decisions on when and how to administer EOAs to patients undergoing THA.
A Call for Comprehensive Policies
The absence of comprehensive policies and prescribing standards, as highlighted by the study, is striking, given the widespread nature of total hip arthroplasties. As Zhao and the research team note in their article, given the dramatic uptick in EOA prescriptions, it is paramount that the orthopedic community, along with health policymakers, work toward establishing guidelines that optimize patient outcomes without contributing unnecessarily to the growth of resistant bacterial strains.
The Essential Role of Future Research and Collaboration
The data presented by Zhao et al. extends beyond a mere analytical study – it calls for a proactive collaboration within the medical community, urging future research to further understand the implications of extended antibiotic use post-THA, the potential for alternative prophylactic strategies, and the importance of a multimodal approach to preventing PJI.
“With the alarming increases in EOA prophylaxis documented in this study, it is critical that we not only develop national guidelines but also continue to investigate the long-term outcomes of such practices,” Zhao remarks. “Our patients’ health and the integrity of our healthcare ecosystem depend on it.”
References
1. Zhao, A. Y., Kuyl, E.-V., Agarwal, A. R., Das, A., Harris, A. B., McDaniel, C. M., Gu, A., Thakkar, S. C., & Golladay, G. J. (2024). Trends in Extended Oral Antibiotic Prophylaxis Utilization Following Primary and Revision Total Hip Arthroplasty from 2010 to 2022. The Journal of Arthroplasty. https://doi.org/10.1016/j.arth.2024.01.016
2. Kurtz, S., Ong, K., Lau, E., Mowat, F., & Halpern, M. (2007). Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. The Journal of Bone and Joint Surgery. American Volume, 89(4), 780–785. https://doi.org/10.2106/JBJS.F.00222
3. Tande, A. J., & Patel, R. (2014). Prosthetic joint infection. Clinical Microbiology Reviews, 27(2), 302–345. https://doi.org/10.1128/CMR.00111-13
4. Uçkay, I., Hoffmeyer, P., Lew, D., & Pittet, D. (2013). Prevention of surgical site infections in orthopaedic surgery and bone trauma: State-of-the-art update. Journal of Hospital Infection, 84(1), 5–12. https://doi.org/10.1016/j.jhin.2013.02.007
5. Zmistowski, B., Della Valle, C., Bauer, T. W., Malizos, K. N., Alavi, A., Bedair, H., et al. (2014). Diagnosis of periprosthetic joint infection. The Journal of Arthroplasty, 29(2 Suppl), 77–83. https://doi.org/10.1016/j.arth.2013.09.037
The increased use of extended oral antibiotic prophylaxis in hip arthroplasty, as captured by Zhao et al.’s research, is a clarion call to action. The time is now for the medical community to come together to create uniform guidelines, ground future practices in evidence-based research, and keep an eye toward the future implications of broad-spectrum antibiotic use.
As this research emerges into widespread discussion, surgeons, patients, and policymakers alike anticipate the development of guidelines that will safeguard patient health while also preventing the overuse of antibiotics—a challenge as pressing as the surgeries themselves.