Advertisement

Intrawound vancomycin powder increases post-operative wound complications and does not decrease periprosthetic joint infection in primary total and unicompartmental knee arthroplasties

  • Mitsuru HanadaEmail author
  • Shoichi Nishikino
  • Kensuke Hotta
  • Hiroki Furuhashi
  • Hironobu Hoshino
  • Yukihiro Matsuyama
KNEE

Abstract

Purpose

A frequent reason for revision surgery after total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA) is periprosthetic joint infection (PJI). The efficacy of intrawound VP in preventing PJI after primary TKA or UKA is rarely reported. The purpose of this study was to investigate the efficacy and side effects of local high-dose VP application to the joint to prevent PJI in TKA and UKA.

Methods

From 2010 to 2017, 166 consecutive patients that underwent primary TKA or UKA were enrolled. Seventy-five patients (92 knees) did not receive VP (control group), while 90 patients (110 knees, VP group) received VP (intrawound, 1 g) before capsule closure during TKA and UKA. Aseptic wound complications, such as skin erosion, wound dehiscence, and prolonged wound healing, were evaluated within 3 months post-operatively. PJI was assessed within a year post-operatively.

Results

Seven patients (7.6%) in the control group and five patients (4.5%) in the VP group had PJI. No significant differences existed in the PJI rates between the groups. Aseptic operative wound complications occurred in 4 patients (4.3%) and 13 patients (11.8%), whereas prolonged operative wound healing occurred in 3 patients (3.3%) and 14 patients (12.7%) of patients in the control and VP group, respectively. Operative wound complications were significantly frequent in the VP group.

Conclusions

Intrawound VP administration does not decrease PJI occurrence in primary TKA and significantly causes aseptic wound complications. The use of intrawound VP for the prevention of PJI after primary TKA and UKA is not recommended.

Level of evidence

Level II.

Keywords

Total knee arthroplasty Unicompartmental knee arthroplasty Vancomycin Wound complication Prosthetic joint infection 

Notes

Acknowledgements

We would like to thank Eisaku Okada who is a statistician for his help of calculation of statistical analysis.

Funding

This study was not externally funded.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the ethics committee of Hamamatsu University School of Medicine (No. 18-283).

References

  1. 1.
    Attar FG, Khaw FM, Kirk LM, Gregg PJ (2008) Survivorship analysis at 15 years of cemented press-fit condylar total knee arthroplasty. J Arthroplasty 23:344–349CrossRefGoogle Scholar
  2. 2.
    Bakhsheshian J, Dahdaleh NS, Lam SK, Savage JW, Smith ZA (2015) The use of vancomycin powder in modern spine surgery: systematic review and meta-analysis of the clinical evidence. World Neurosurg 83:816–823CrossRefGoogle Scholar
  3. 3.
    Bengtson S, Knutson K (1991) The infected knee arthroplasty. A 6-year follow-up of 357 cases. Acta Orthop Scand 62:301–311CrossRefGoogle Scholar
  4. 4.
    Brown NM, Cipriano CA, Moric M, Sporer SM, Della Valle CJ (2012) Dilute betadine lavage before closure for the prevention of acute postoperative deep periprosthetic joint infection. J Arthroplasty 27:27–30CrossRefGoogle Scholar
  5. 5.
    Chiang CC, Chiu FY (2012) Cefuroxime-impregnated cement and systemic cefazolin for 1 week in primary total knee arthroplasty: an evaluation of 2700 knees. J Chin Med Assoc. 75:167–170CrossRefGoogle Scholar
  6. 6.
    Chiu FY, Chen CM, Lin CF, Lo WH (2002) Cefuroxime-impregnated cement in primary total knee arthroplasty: a prospective, randomized study of three hundred and forty knees. J Bone Joint Surg Am 84:759–762CrossRefGoogle Scholar
  7. 7.
    Chiu FY, Lin CF (2009) Antibiotic-impregnated cement in revision total knee arthroplasty. A prospective cohort study of one hundred and eighty-three knees. J Bone Joint Surg Am 91:628–633CrossRefGoogle Scholar
  8. 8.
    de Steiger RN, Miller LN, Davidson DC, Ryan P, Graves SE (2013) Joint registry approach for identification of outlier prostheses. Acta Orthop 84:348–352CrossRefPubMedCentralGoogle Scholar
  9. 9.
    Dial BL, Lampley AJ, Green CL, Hallows R (2018) Intrawound vancomycin powder in primary total hip arthroplasty increases rate of sterile wound complications. Hip Pelvis 30:37–44CrossRefPubMedCentralGoogle Scholar
  10. 10.
    Everhart JS, Andridge RR, Scharschmidt TJ, Mayerson JL, Glassman AH, Lemeshow S (2016) Development and validation of a preoperative surgical site infection risk score for primary or revision knee and hip arthroplasty. J Bone Joint Surg Am 98:1522–1532CrossRefGoogle Scholar
  11. 11.
    Ghobrial GM, Cadotte DW, Williams K Jr, Fehlings MG, Harrop JS (2015) Complications from the use of intrawound vancomycin in lumbar spinal surgery: a systematic review. Neurosurg Focus 39:E11CrossRefGoogle Scholar
  12. 12.
    Hoelen DW, Tjan DH, van Vugt R, van der Meer YG, van Zanten AR (2007) Severe local vancomycin induced skin necrosis. Br J Clin Pharmacol 64:553–554CrossRefPubMedCentralGoogle Scholar
  13. 13.
    Insall JN (1988) Presidential address to the Knee Society: choices and compromises in total knee arthroplasty. Clin Orthop Relat Res 226:43–48Google Scholar
  14. 14.
    Johnson JD, Nessler JM, Horazdovsky RD, Vang S, Thomas AJ, Marston SB (2015) Serum and wound vancomycin levels after intrawound administration in primary total joint arthroplasty. J Arthroplasty 32:924–928CrossRefGoogle Scholar
  15. 15.
    Kang DG, Holekamp TF, Wagner SC, Lehman RA Jr (2015) Intrasite vancomycin powder for the prevention of surgical site infection in spine surgery: a systematic literature review. Spine J 15:762–770CrossRefGoogle Scholar
  16. 16.
    Miller R, McLaren A, Leon C, McLemore R (2012) Mixing method affects elution and strength of high-dose ALBC: a pilot study. Clin Orthop Relat Res 470:2677–2683CrossRefPubMedCentralGoogle Scholar
  17. 17.
    Naendrup JH, Marche B, de Sa D, Koenen P, Otchwemah R, Wafaisade A, Pfeiffer TR (2019) Vancomycin-soaking of the graft reduces the incidence of septic arthritis following ACL reconstruction: results of a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc.  https://doi.org/10.1007/s00167-019-05353-1 (Epub ahead of print) Google Scholar
  18. 18.
    Neut D, Kluin OS, Thompson J, van der Mei HC, Busscher HJ (2010) Gentamicin release from commercially-available gentamicin-loaded PMMA bone cements in a prosthesis-related interfacial gap model and their antibacterial efficacy. BMC Musculoskelet Disord 10(11):258CrossRefGoogle Scholar
  19. 19.
    Offerhaus C, Balke M, Hente J, Gehling M, Blendl S, Höher J (2019) Vancomycin pre-soaking of the graft reduces postoperative infection rate without increasing risk of graft failure and arthrofibrosis in ACL reconstruction. Knee Surg Sports Traumatol Arthrosc.  https://doi.org/10.1007/s00167-018-5323-6 Google Scholar
  20. 20.
    O’Neill KR, Smith JG, Abtahi AM, Archer KR, Spengler DM, McGirt MJ, Devin CJ (2011) Reduced surgical site infections in patients undergoing posterior spinal stabilization of traumatic injuries using vancomycin powder. Spine J 11:641–646CrossRefGoogle Scholar
  21. 21.
    Otte JE, Politi JR, Chambers B, Smith CA (2017) Intrawound vancomycin powder reduces early prosthetic joint infections in revision hip and knee arthroplasty. Surg Technol Int 30:284–289Google Scholar
  22. 22.
    Parvizi J, Saleh KJ, Ragland PS, Pour AE, Mont MA (2008) Efficacy of antibiotic-impregnated cement in total hip replacement. Acta Orthop 79:335–341CrossRefGoogle Scholar
  23. 23.
    Parvizi J, Gehrke T, Chen AF (2013) Proceedings of the international consensus on periprosthetic joint infection. Bone Joint J 95-B:1450–1452CrossRefGoogle Scholar
  24. 24.
    Petrie RS, Hanssen AD, Osmon DR, Ilstrup D (1998) Metal-backed patellar component failure in total knee arthroplasty: a possible risk for late infection. Am J Orthop (Belle Mead NJ) 27:172–176Google Scholar
  25. 25.
    Phegan M, Grayson JE, Vertullo CJ (2016) No infections in 1300 anterior cruciate ligament reconstructions with vancomycin pre-soaking of hamstring grafts. Knee Surg Sports Traumatol Arthrosc 24:2729–2735CrossRefGoogle Scholar
  26. 26.
    Qadir R, Ochsner JL, Chimento GF, Meyer MS, Waddell B, Zavatsky JM (2014) Establishing a role for vancomycin powder application for prosthetic joint infection prevention-results of a wear simulation study. J Arthroplasty 29:1449–1456CrossRefGoogle Scholar
  27. 27.
    Ritter MA (1977) The Herbert total knee replacement: a longer than three year follow-up. Clin Orthop Relat Res 129:232–235CrossRefGoogle Scholar
  28. 28.
    Ritter MA, Davis KE, Meding JB, Pierson JL, Berend ME, Malinzak RA (2011) The effect of alignment and BMI on failure of total knee replacement. J Bone Joint Surg Am 93:1588–1596CrossRefGoogle Scholar
  29. 29.
    Scuderi GR, Insall JN, Windsor RE, Moran MC (1989) Survivorship of cemented knee replacements. J Bone Joint Surg Br 71:798–803CrossRefGoogle Scholar
  30. 30.
    Shahi A, Parvizi J (2015) Prevention of periprosthetic joint infection. Arch Bone Joint Surg 3:72–81Google Scholar
  31. 31.
    Strom RG, Pacione D, Kalhorn SP, Frempong-Boadu AK (2013) Decreased risk of wound infection after posterior cervical fusion with routine local application of vancomycin powder. Spine (Phila Pa 1976) 38:991–994CrossRefGoogle Scholar
  32. 32.
    Sweet FA, Roh M, Sliva C (2011) Intrawound application of vancomycin for prophylaxis in instrumented thoracolumbar fusions: efficacy, drug levels, and patient outcomes. Spine (Phila Pa 1976) 36:2084–2088CrossRefGoogle Scholar
  33. 33.
    Tubaki VR, Rajasekaran S, Shetty AP (2013) Effects of using intravenous antibiotic only versus local intrawound vancomycin antibiotic powder application in addition to intravenous antibiotics on postoperative infection in spine surgery in 907 patients. Spine (Phila Pa 1976) 38:2149–2155CrossRefGoogle Scholar
  34. 34.
    Vander Salm TJ, Okike ON, Pasque MK, Pezzella AT, Lew R, Traina V, Mathieu R (1989) Reduction of sternal infection by application of topical vancomycin. J Thorac Cardiovasc Surg 98:618–622Google Scholar
  35. 35.
    Vertullo CJ, Quick M, Jones A, Grayson JE (2012) A surgical technique using presoaked vancomycin hamstring grafts to decrease the risk of infection after anterior cruciate ligament reconstruction. Arthroscopy 28:337–342CrossRefGoogle Scholar
  36. 36.
    Vince KG, Insall JN, Kelly MA (1989) The total condylar prosthesis: 10- to 12-year results of a cemented knee replacement. J Bone Joint Surg Br 71:793–797CrossRefGoogle Scholar
  37. 37.
    Xie LL, Zhu J, Yang MS, Yang CY, Luo SH, Xie Y, Pu D (2017) Effect of intra-wound vancomycin for spinal surgery: a systematic review and meta-analysis. Orthop Surg 9:350–358CrossRefGoogle Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryHamamatsu University School of MedicineHamamatsuJapan

Personalised recommendations