Dual Antibiotic Therapy with Vancomycin and Cefazolin for Surgical Prophylaxis in Total Knee Arthroplasty


  • Anna Cohen-Rosenblum University of Virginia
  • Madison Crutcher University of Virginia
  • Jane Gui University of Virginia
  • Wendy Novicoff University of Virginia
  • Stephen Nelson University of Virginia
  • James Browne University of Virginia




Antibiotic Prophylaxis, Primary Total Knee Arthroplasty, Infection, Renal Failure


Background: Perioperative administration of intravenous antibiotics is a routine part of total knee arthroplasty.  Antibiotic selection is a matter of controversy, and the potential risks and benefits associated with each antibiotic selection need to be considered.  The objective of this study is to examine the effects of routine dual antibiotic prophylaxis with both cefazolin and vancomycin on infection and renal failure after primary total knee arthroplasty (TKA) compared with cefazolin alone.

Methods: We performed a retrospective review of primary TKA patients for two years before and two years after routine dual antibiotic prophylaxis was implemented at our institution. 1502 patients were included (567 cefazolin-only and 935 dual prophylaxis).  

Results: 2 patients (0.4%) in the cefazolin-only group had a deep surgical site infection, compared with 13 patients (1.4%) in the dual prophylaxis group (p=0.06). 46 patients (8.1%) in the cefazolin-only group had postoperative renal failure, compared with 36 patients (3.9%) in the dual prophylaxis group (p=0.0006).

Discussion and Conclusion: Our results did not support the routine use of vancomycin in primary total joint arthroplasty to decrease periprosthetic joint infection. However, we also did not see any clear harm due to renal failure in the routine use of dual antibiotic prophylaxis. 


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How to Cite

Cohen-Rosenblum, A., Crutcher, M., Gui, J., Novicoff, W., Nelson, S., & Browne, J. (2018). Dual Antibiotic Therapy with Vancomycin and Cefazolin for Surgical Prophylaxis in Total Knee Arthroplasty. Reconstructive Review, 8(2). https://doi.org/10.15438/rr.8.2.212



Original Article