Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.
World J Orthop. Jun 18, 2026; 17(6): 119301
Published online Jun 18, 2026. doi: 10.5312/wjo.v17.i6.119301
Published online Jun 18, 2026. doi: 10.5312/wjo.v17.i6.119301
Extended antibiotic prophylaxis in primary total knee arthroplasty: A narrative review of current evidence and controversies
Tarun Jayakumar, Department of Orthopaedics, KIMS-Sunshine Hospital, Hyderabad 500003, Telangana, India
Naveen Jeyaraman, Madhan Jeyaraman, Department of Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai 600077, Tamil Nadu, India
Naveen Jeyaraman, Arulkumar Nallakumarasamy, Sathish Muthu, Madhan Jeyaraman, De
Naveen Jeyaraman, Sathish Muthu, Madhan Jeyaraman, Department of Orthopaedics, Ortho
Arulkumar Nallakumarasamy, Department of Orthopaedics, Jawaharlal Institute of Postgraduate Medical Education and Research, Karaikal 609602, Puducherry, India
Sathish Muthu, Central Research Laboratory, Meenakshi Medical College Hospital and Research Institute, Meenakshi Academy of Higher Education and Research, Kanchipuram 631552, Tamil Nadu, India
Co-first authors: Tarun Jayakumar and Naveen Jeyaraman.
Author contributions: Jayakumar T and Jeyaraman N have played important roles in manuscript preparation as co-first authors; Jayakumar T, Jeyaraman N, and Jeyaraman M contributed to conceptualization; Jayakumar T, Nallakumarasamy A, and Jeyaraman M contributed to manuscript writing; Jeyaraman N and Muthu S contributed to acquiring clinical data and performing the data analysis; Muthu S and Jeyaraman M helped in manuscript revision; Jeyaraman M contributed to proofreading and administration; all authors have agreed to the final version to be published and agree to be accountable for all aspects of the work.
AI contribution statement: No AI tools were used to write the manuscript. Grammarly is a built-in software used to correct grammar errors.
Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.
PRISMA 2009 Checklist statement: Not applicable.
Corresponding author: Madhan Jeyaraman, MD, PhD, Researcher, Department of Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Velap
Received: January 26, 2026
Revised: February 1, 2026
Accepted: April 21, 2026
Published online: June 18, 2026
Processing time: 144 Days and 20.5 Hours
Revised: February 1, 2026
Accepted: April 21, 2026
Published online: June 18, 2026
Processing time: 144 Days and 20.5 Hours
Core Tip
Core Tip: Extended oral antibiotic prophylaxis after primary total knee arthroplasty has not demonstrated consistent benefit in reducing periprosthetic joint infection compared with standard ≤ 24-hour regimens. While early retrospective data suggested possible value in high-risk patients, larger studies and meta-analyses show no advantage and highlight antimicrobial resistance concerns. Current international guidelines recommend limiting prophylaxis to 24 hours, with future randomized trials needed to clarify extended oral antibiotic’s role in selected populations.