Antibiotic prophylaxis for orthopaedic implant removal: what does the evidence say?

Abstract: Orthopaedic implant removal is considered as a sterile procedure, but the current literature suggests it is associated with around 20% Surgical Site Infection (SSI) rate. Use of antibiotic prophylaxis is still ambiguous and contentious. Taking into consideration this issue we conducted a meta-analysis for use of antibiotic prophylaxis in orthopaedic implant removal surgery. Objectives: : To determine whether antibiotic prophylaxis benefits orthopaedic implant removal surgeries or not. Methods: Electronic and printed sources were searched up to February, 2021 for randomised controlled trials (RCTs) using antibiotic prophylaxis and control group. Data from eligible studies were pooled for the following outcomes: overall, superficial and deep surgical site infection (SSI). Pooled odds ratios with 95% confidence interval (CI) were calculated using Mantel Haensnzel 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 prior to removal of orthopaedic implants