May 2026

ORTHOPAEDICS

NON-CEFAZOLIN ANTIBIOTIC PROPHYLAXIS IS ASSOCIATED WITH INCREASED PJI RISK AFTER TKA

A Northwestern Medicine study, published in The Journal of Arthroplasty, analyzed a national database of 528,250 primary total knee arthroplasty (TKA) cases performed between 2016 and 2022 to clarify whether perioperative antibiotic selection influences 90‑day periprosthetic joint infection (PJI) risk.

Key Findings
  • Cefazolin-based prophylaxis, alone or with an additional antibiotic, significantly reduced PJI risk compared with non-cefazolin alternatives.
  • PJI rates: 0.7% with cefazolin vs. 1.0% with non-cefazolin.
  • After adjustment for patient factors, cefazolin remained protective, showing lower odds of PJI across all analyses.

Clinical Implications
Cefazolin should remain the first-line prophylactic agent for primary TKA when patients can safely receive it. Alternatives should be reserved for true allergies, and further research is needed for patients with allergy concerns or elevated infection risk.
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Read the full study
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Adam I. Edelstein, MD, the Clifford C. Raisbeck Professor of Orthopaedic Surgery at Northwestern Medicine, was a co-author of the study.

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