Prophylactic antibiotics only protect a joint replacement if tissue levels are adequate when the skin is cut. Give the dose within 60 minutes before incision; vancomycin needs a longer infusion, so start it 60 to 120 minutes before. Weight-based dosing matters, and cefazolin should be increased in heavier patients.
If a tourniquet is used, the infusion should be complete before it is inflated. Redose during long operations or after heavy blood loss, and do not continue prophylaxis beyond 24 hours, which adds harm without reducing infection. A reported penicillin allergy is often not a true allergy; clarifying it allows cefazolin rather than a less effective alternative.
- Give the prophylactic dose within 60 minutes before incision.
- Start vancomycin 60 to 120 minutes before incision.
- Complete the infusion before inflating a tourniquet.
- Redose for long operations or heavy blood loss.
- Stop prophylaxis within 24 hours after surgery.
Why it matters
Prophylaxis given at the wrong time is a missed chance to prevent periprosthetic infection.
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