Ka. Young et al., AUDIT OF ANTIBIOTIC-PROPHYLAXIS IN HIP AND KNEE ARTHROPLASTY, Journal of the Royal College of Surgeons of Edinburgh, 42(2), 1997, pp. 112-115
The aim of this audit was to highlight inadequacies in the use of cefu
roxime prophylaxis for primary hip and knee arthroplasties carried out
in the Apr Hospital. Initially 50 consecutive primary hip and knee ar
throplasties were audited prospectively commencing August 1995. A samp
le of cancellous bone was harvested at the time of the first bone cut
and the bone cefuroxime level was assayed, and compared with the stand
ard. The results of the initial audit highlighted gross inadequacies i
n attaining the standard in hip and especially in knee arthroplasty us
ing the variable existing systemic intravenous regimens. The regional
antibiotic regimen was, however, deemed reliable. We elected to standa
rdize the regimens to an intravenous bolus of 1.5 g cefuroxime deliver
ed on entering the anaesthetic room, in the case of a single surgeon c
ontinued with the regional route for knee arthroplasties using the tou
rniquet. A further 50 cases were compiled, the results of which demons
trate a significant improvement in the cefuroxime levels attained in k
nee arthroplasty by the intravenous bolus regimen, and consistently hi
gh levels in knee arthroplasty by regional administration. Adequate ce
furoxime levels are not guaranteed simply by the pre-operative adminis
tration of the drug, and significant improvements can be made by atten
tion to the timing of administration, particularly in knee arthroplast
y using the tourniquet. We also find regional cefuroxime administratio
n in total knee arthroplasty a more reliable means of attaining supra-
threshold levels.