Minimally Invasive Total Knee Arthroplasty Medication

Updated: Jun 17, 2021
  • Author: Derek F Amanatullah, MD, PhD; Chief Editor: Erik D Schraga, MD  more...
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Medication Summary

The goals of pharmacotherapy are to reduce morbidity and prevent complications.



Class Summary

The American Academy of Orthopaedic Surgeons (AAOS) has recommended the use of prophylactic antibiotics that include cefazolin, cefuroxime, or vancomycin. The antibiotics should be administered 60 minutes prior to the procedure and discontinued within 24 hours after the procedure. However, for outpatient/office-based procedures, a single dose before the procedure is sufficient.


Cefazolin is a first-generation semisynthetic cephalosporin that arrests bacterial cell wall synthesis, inhibiting bacterial growth.

Cefuroxime (Ceftin, Zinacef)

Cefuroxime is a second-generation cephalosporin that maintains the gram-positive activity of first-generation cephalosporins; it adds activity against Proteus mirabilis, Haemophilus influenzae, Escherichia coli, Klebsiella pneumoniae, and Moraxella catarrhalis. The condition of the patient, the severity of the infection, and the susceptibility of the microorganism determine the proper dose and route of administration.


Vancomycin is a potent antibiotic that is directed against gram-positive organisms and that is active against Enterococcus species. It is useful in the treatment of septicemia and skin structure infections. Vancomycin is indicated for patients who cannot receive or have not responded to penicillins and cephalosporins and for patients who have infections with resistant staphylococci.


Anticoagulants, Hematologic

Class Summary

To prevent deep venous thrombosis, as well as pulmonary embolism, patients should be on an appropriate anticoagulation regimen, as recommended by the AAOS. Currently, there is no consensus among orthopaedic surgeons regarding the choice of pharmacologic prophylaxis. A retrospective study of 113 patients found no difference in thromboembolic events or bleeding complications between minimally invasive and conventional total knee arthroplasty TKA patients treated postoperatively with either enoxaparin or rivaroxaban. [49]