BACKGROUND. The incidence of postoperative infection in the United States is 5.4%/4.8% for patients undergoing THA and TKA, respectively. The risk of postoperative infection increases by 6.7 times in operations on patients with severe obesity, those with a BMI greater than 35 kg/m2. These infections not only increase morbidity and mortality, but increase the average hospital stay by and could lead to recurrence of surgery. Infection rates are statistically significantly higher in the patient population with a BMI over 35 kgm2. Postoperative infection can be prevented by the use of antibiotics. The use of extended use prophylaxis antibiotics have been proposed in high risk populations undergoing TKA/THA in order to mitigate the infection rates. The standard regimen for extended use of prophylaxis antibiotics is prophylactic oral antibiotics a minimum of 7 days after discharge (500 mgs Cefadroxil twice daily for 7 days or 300 mg Clindamycin three times a day for 7 days if anaphylactic reaction to cephalosporins). Recent studies have explored the impact that extended use of prophylactic antibiotics have on reducing the rates of postoperative infection in the patient population with a BMI over 35 kg/m2. METHODS. A systematic search identified studies regarding the use of an extended prophylaxis antibiotic regimen among TKA/THA patients with a BMI over 35 kg/m2. All data was obtained using published peer-reviewed journal articles from PubMed and Google Scholar using the keywords, “TKA+Infection”, “THA+Infection”, “THA+Prophylaxis”, “TKA+Prophylaxis”, “TKA+BMI,” and “THA+BMI.” The data was not limited to a particular time frame. RESULTS. Studies noted a 81% reduction in PJI in patients undergoing THA/TKA with a BMI over 35 kg/m2 when treated with prophylaxis extended antibiotic therapy. Evidence of an incidence reduction of 3.9% to 0.0% was statistically significant in patients with a BMI over 40 kg/m2 treated with extended antibiotic prophylaxis. CONCLUSIONS. The data shows that extended antibiotic prophylaxis prevents postoperative infection in high-risk patients with a BMI over 35 kg/m2 undergoing TKA/THA procedures. More research needs to be done to standardize a method of prophylaxis, but extended antibiotic prophylaxis seems to help this high risk population

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