Prophylactic antibiotics for joint replacement work only if tissue levels are adequate when the skin is opened. Cefazolin should finish infusing within 60 minutes before incision, with the dose adjusted for body weight and repeated if surgery runs long or blood loss is heavy.
Giving it too early, or after the tourniquet is inflated, leaves the wound unprotected at the moment of contamination.
- Complete cefazolin infusion within 60 minutes before incision.
- Use a weight-adjusted dose, increasing it in heavier patients.
- Redose during long operations or after major blood loss.
- Give the antibiotic before inflating any tourniquet.
Why it matters
Mistimed prophylaxis is one of the most avoidable contributors to periprosthetic joint infection.
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