Clinical Study Of Different Ways To Use Parenteral Prophylactic Antibiotics In Total Knee Arthroplasty

Objective: By analyzing and comparing the clinical prevention efficacybetween the four-day and two-day regimen of parenteral prophylacticantibiotics used in total knee arthroplasty(TKA), to conduct how toscientifically and reasonably use antibiotics in perioperative period ofTKA.Methods: We selected326TKA in osteoarthritis Ⅳ stage patients fromJanuary2008to December2012in the First Affiliated Hospital of DalianMedical University（Female195、Male131；Cefazolin293、ClindamycinCLDM33）,and divided into2groups equally. Group A (144casesincluding cefazolin129and CLDM15) was treated with a four-dayregimen of parenteral prophylactic antibiotics, and group B (182casesincluding cefazolin163and CLDM19) with a two-day regimen ofparenteral prophylactic antibiotics. It is a retrospective study bycollecting the clinical cases、 iconography dates、 ecsomatics dates, weobserved and calculated the postoperative time in hospital、 thepostoperative time before taking out stitches、the postoperative current ofvital signs、 the postoperative dates of clinical exams、 the postoperativerecovering situation of the wound and the postoperative HSS dates in thedifferent regimens of parenteral prophylactic antibiotics.Results： The elementary dates of Group A with a four-day regimen ofparenteral prophylactic antibiotics as follow：144patients、 the ratebetween men and women58/86、 ages （66.8±6.2） years old、 BMI（21.5±1.8）、the total time of operation（112±21）minutes，and theelementary dates of Group A with a two-day regimen of parenteral prophylactic antibiotics as follow：182patients、the rate between men andwomen69/113、ages（65.9±7.4）years old、BMI （21.9±2.1）、the totaltime of operation （108±18） minutes， then there are no significantdifferences between the two groups (P>0.05). The postoperative time inhospital of Group A is （15.3±3.7） days， and the postoperative time inhospital of Group B is （14.9±3.6） days， then there are no significantdifferences between the two groups (P>0.05).There are136cases whichoutcome of temperature and WBC completed before the5t hday afteroperation in Group A， and there are171cases in Group B， then there areno significant differences between the two groups (P>0.05).There are137cases which tendency of the postoperative CRP and ESR dates begandescending after the7t hday in Group A， and there are173cases in GroupB， then there are no significant differences between the two groups(P>0.05). The postoperative time before taking out stitches of Group Ais（14.3±3.2）days，and the postoperative time before taking out stitchesof Group B is（14.9±2.9） days， then there are no significant differencesbetween the two groups (P>0.05).There are6cases of superficial woundinfection（uninvolved joint capsule）and no cases of deep wound infection（involved joint capsule）in Group A，and there are5cases of superficialwound infection and1case of deep wound infection in Group B， thenthere are no significant differences between the two groups(P>0.05).There are6cases of early wound infection（during2weeksafter operation）and no cases of delayed wound infection（beyond2weeksafter operation）in Group A，and there are5cases of early wound infectionand1case of delayed wound infection in Group B， then there are nosignificant differences between the two groups (P>0.05).4cases ofwound infection in Group A were treated by changing antibiotics tovancomycin then the infection were controlled， and1case of woundinfection in Group A was treated by using a combination of cefoperazonethen the infection was controlled。6cases of wound infection in Group Bwere completely treated by changing antibiotics to vancomycin，including 5cases’ infection having been controlled.1case of delayed woundinfection in Group B was treated by using debridement and changingantibiotics to vancomycin then the infection was controlled. All patientspreoperative and postoperative HSS scores are statistically significant(p<0.01), and the difference of HSS scores between the two groups afteroperation and improvement rates are not statistically significant(p>0.05).Conclusion： Both regimens of parenteral prophylactic antibiotics to beused in total knee arthroplasty（TKA）can achieve the satisfied effection，and there are no significant differences between the two groups. Thetwo-day regimen of parenteral prophylactic antibiotics in TKA is safe andeffective. In order to lightening the patients’ economic pressures andminimizing the occurrence of drug resistance， shorter antibioticprophylaxis regimens are recommended for TKA while therecommendation should be made on the basis of personal clinicalexperiences and the respective medical environment.