Primary hip or knee arthroplasty in the setting of chronic suppressive antibiotics for prior periprosthetic joint infection: a scoping review

Background: Total joint arthroplasty (TJA) is an increasingly common intervention in the US, with an expected proportionate rise in periprosthetic joint infection (PJI). As part of the treatment plan, long-term suppressive oral antibiotic therapy is sometimes used in patients who would not benefit from further surgical intervention of their PJI. The aim of this scoping review is to outline the current evidence surrounding PJI incidence in new primary arthroplasty in this patient population. Methods: A search was conducted using the PubMed and Scopus databases with no date restrictions. Studies examining the incidence of developing a PJI after new primary hip or knee arthroplasty in patients receiving chronic suppressive antibiotic therapy for a prior PJI were included. Two authors independently screened the results for inclusion in this review. Results: Three retrospective cohort studies were ultimately included. Across studies, 61 patients with prior PJI receiving chronic suppressive antibiotics undergoing new primary TJA were identified. PJI rates in suppressed patients ranged from 0 % to 21.4 % compared to 0 % to 2.9 % in non-suppressed patients with prior PJI and 0 % to 2.6 % in matched controls without prior PJI. Conclusion: Limited evidence exists regarding PJI risk in new primary arthroplasty among patients on chronic suppression for prior PJI, with a wide range of incidence reported across studies. Due to a lack of direct evidence examining this specific patient population, further research must be conducted in order to support strong recommendations.