What is the dermatologic preoperative evaluation and management of prosthetic joints?

Updated: Mar 16, 2020
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
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Answer

Answer

The issue of chemoprophylaxis for prosthetic joint infections is controversial. According to a review by Choi, most routine prophylaxis for patients with prosthetic joints is not necessary. [14] Two other authors, based on their cost-to-benefit analysis, disagree with withholding antibiotic prophylaxis. They suggest that antibiotic prophylaxis should be administered to patients likely to have a poor outcome and to those patients at higher risk for infection, such as those with rheumatoid arthritis or chronic debilitating diseases and those on immunomodulatory medications.

Choi's summary of the available studies concludes that advocating routine antibiotic prophylaxis for most invasive procedures in patients with prosthetic joints is difficult, but targeting prophylaxis to patients at greater risk of poor outcomes is probably prudent. Antibiotic prophylaxis should cover the major pathogens (S aureus and Staphylococcus epidermidis). A first-generation cephalosporin, clindamycin, dicloxacillin, and vancomycin are all appropriate choices.


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