Twenty-four Hours of Perioperative Oral Antibiotics Results in Low Rate of Prosthetic Joint Infection Following Outpatient Arthroplasty Procedures

Background: Prosthetic joint infection (PJI) is a devastating complication following hip and knee arthroplasty, with significant morbidity and mortality. While 24 hours of intravenous antibiotics is standard for inpatient arthroplasty, there is no consensus on postoperative antibiotic prophylaxis for outpatient procedures. This study evaluated 90-day PJI rates in patients undergoing same-day discharge primary hip and knee arthroplasty with 24 hours of perioperative oral antibiotics. Methods: A retrospective review was conducted on 1,843 patients who underwent primary total knee arthroplasty (TKA; 1,052, 57.1%), total hip arthroplasty (THA; 638, 34.7%), unicompartmental knee replacements (medial: 89, 4.8%; lateral: 5, 0.3%), isolated patellofemoral replacements (14, 0.8%), or conversion of previous hip surgeries (4, 0.2%) from 2021 to 2023 at two ambulatory surgery centers. All patients received 24 hours of perioperative oral antibiotics. Patient data were collected via chart review and the Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI). The primary outcome was PJI within 90 days of surgery. Results: The median age was 66 years, and the median BMI was 31 kg/m². PJI occurred in 5 patients (0.3%; 3 THA, 2 TKA). There were no significant differences in PJI rates based on gender, BMI, race, smoking status, diabetes, ASA class, procedure type, or surgical approach (P < 0.05). Conclusion: Twenty-four hours of perioperative oral antibiotics following outpatient TKA, THA, unicompartmental, and patellofemoral procedures is associated with low PJI rates. Larger, randomized prospective studies are needed to refine antibiotic protocols for outpatient arthroplasty.