Title:Antibiotic Prophylaxis for Orthopaedic Implant Removal: What Does the
Evidence Say?
Volume: 18
Issue: 1
Author(s): Imran Ibni Gani Rather, Nusrat Shafiq*, Avaneesh Kumar Pandey, Ritika Kondel Bhandari, Samir Malhotra and Devinder Kumar Chouhan
Affiliation:
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Keywords:
Antibiotic prophylaxis, orthopaedic implant, surgical site infection, superficial surgical site infection, deep-seated surgical site infection, fractures.
Abstract:
Orthopaedic implant removal is considered a sterile procedure, but the current literature
suggests it is associated with around a 20% Surgical Site Infection (SSI) rate. The use of antibiotic
prophylaxis is still ambiguous and contentious. Taking into consideration this issue we conducted a
meta-analysis for the use of antibiotic prophylaxis in orthopaedic implant removal surgery.
Objectives: To determine whether or not antibiotic prophylaxis benefits orthopaedic implant removal
surgeries.
Methods: Electronic and printed sources were searched up to February 2021 for randomised controlled
trials (RCTs) using antibiotic prophylaxis and a control group. Data from eligible studies
were pooled for the following outcomes: overall, superficial, and deep surgical site infection (SSI).
Pooled odds ratios with a 95% confidence interval (CI) were calculated using Mantel Haenszel
fixed-effect model preferentially.
Results: Two studies, including 766 patients were included in this meta-analysis. Heterogeneity
was not statistically significant between the studies. There was no significant difference in the incidence
of overall SSI in cefazolin and normal saline (NS) groups (Pooled OR 0.79; 95% CI 0.53-
1.17). In subgroup analysis, antibiotic prophylaxis showed statistically significant improvement for
deep SSI (Pooled OR 0.20; 95% CI 0.06-0.70).
Conclusion: Overall incidence of SSI is not reduced after the administration of antibiotic prophylaxis
one hour before removal of orthopaedic implants.
