Antibiotic prophylaxis for arthroscopic surgery.

Because the incidence of infection in arthroscopic surgery is very low, one can argue both for and against the use of prophylactic antibiotics. Administering antibiotics adds expense and introduces the potential for both exposure to allergic reactions and selection of resistant organisms. Antibiotics are given to prevent deep infection; such treatment may require further surgery, prolonged use of intravenous antibiotics, high costs, and outcomes that may be less than satisfactory. An answer to this controversial issue would require a study that includes large numbers of patients to make it adequately statistically powered because the incidence of infection is so low. No such research has yet been performed, and the American Academy of Orthopaedic Surgeons (AAOS) has not produced an advisory statement addressing this issue. It is the opinion of this author that antibiotic prophylaxis is indicated for arthroscopic surgery. Despite surgical team best practices, mistakes can occur. This has led the AAOS to issue an advisory statement to prevent wrong-site surgery. Similarly, complacency with repetition may produce breaks in sterility that may occasionally go undetected. Antibiotic usage may help to reduce infection in such circumstances. Arthroscopic procedures are not always performed in healthy patients. The risk of infection in "high-risk" patients, such as those with diabetes, immune problems, and skin disorders, may be reduced by prophylactic antibiotics. How one defines a case as arthroscopic can be debated. If small incisions are made, or if the scope is used for only a portion of the procedure, many would still consider the case to be arthroscopic. Surgeries are becoming more complex, which adds to their duration. Some cases also involve the use of implants such as interference screws and suture anchors. It is my opinion that antibiotics should be used in these situations. The potential exists for litigation in cases of infection. Medicolegally, it is easier to argue that all measures were taken to prevent infection if prophylactic antibiotics were given, although patient care issues supersede defensive medicine. Risk of infection in arthroscopic surgery is multifactorial, and antibiotic prophylaxis is only one facet of the issue. Although it is my opinion that antibiotics are recommended, others could be justified in supporting the opposite opinion, pending appropriately designed and adequately powered future investigations.