AUDIT OF ANTIBIOTIC-PROPHYLAXIS IN HIP AND KNEE ARTHROPLASTY

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.