Single-Dose Versus Extended Antibiotic Prophylaxis in Primary Hip and Knee Arthroplasty: A Systematic Review and Meta-Analysis.

The optimal duration of antibiotic prophylaxis for patients undergoing primary hip or knee arthroplasty remains debated. We conducted a systematic review and meta-analysis to compare the outcomes of single-dose versus extended antibiotic prophylaxis. Studies assessing these strategies for periprosthetic joint infection (PJI), revision surgery, and superficial surgical site infections were selected from systematic searches in PubMed, Embase, and the Cochrane Library. Results were synthesized using random-effects meta-analysis models. Nine studies were included, covering 295,654 patients - 125,489 undergoing total knee arthroplasty and 172,055 undergoing total hip arthroplasty. A significant statistical difference in the incidence of PJI favored single-dose over extended antibiotic prophylaxis (OR 0.78; 95% CI 0.63-0.98; I² = 0%). Our meta-analysis suggests that a single-dose prophylactic antibiotic regimen may be preferable for reducing PJI incidence in primary total hip and knee arthroplasty.