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No effect of vancomycin powder to prevent infection in primary total knee arthroplasty: a retrospective review of 976 cases

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Vancomycin powder (VP) has been used to prevent periprosthetic joint infection (PJI). However, studies investigating the efficacy of VP to prevent infection in primary total knee arthroplasty (TKA) are very rare. The purpose of this study was to investigate the efficacy of VP application to prevent PJI in TKA.

Methods

Between 2012 and 2016, 976 consecutive patients who underwent primary TKA were included in the present study. Patients were divided into two groups. There were 474 patients (48.6%) in the VP group and 502 patients in the control group (51.4%). Except for VP, all procedures were the same in both groups. In the VP group, 2 g of VP was poured into the joint just before the fascia was closed. Average follow-up was 53.2 months (24–84 months).

Results

Infection was found in 4 (0.84%) of 474 patients in the VP group and 5 (0.99%) of 502 patients in the control group. There was no statistically significant difference between groups in terms of infection rates (p = 0.535). Staphylococcus aureus was found in 2 patients in the VP group. Two patients had S. aureus and 1 patient had Pseudomonas aeruginosa in the control group. There was no statistically significant difference between groups in terms of demographic parameters (p > 0.05).

Conclusion

Intrawound VP administration doesn’t change the infection rates in primary TKA. The VP administration for preventing PJI is not recommended in primary TKA.

Level of evidence

III.

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References

  1. Adogwa O, Elsamadicy AA, Sergesketter A et al (2017) Prophylactic use of intraoperative vancomycin powder and postoperative infection: an analysis of microbiological patterns in 1200 consecutive surgical cases. J Neurosurg Spine 27:328–334

    Article  Google Scholar 

  2. Caroom C, Moore D, Mudaliar N et al (2018) Intrawound vancomycin powder reduces bacterial load in contaminated open fracture model. J Orthop Trauma 32:538–541

    Article  Google Scholar 

  3. 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 30:37–44

    Article  Google Scholar 

  4. Ghobrial GM, Thakkar V, Andrews E et al (2014) Intraoperative vancomycin use in spinal surgery: single institution experience and microbial trends. Spine 39:550–555

    Article  Google Scholar 

  5. Grabel ZJ, Boden A, Segal DN, Boden S, Milby AH, Heller JG (2018) The impact of prophylactic intraoperative vancomycin powder on microbial profile, antibiotic regimen, length of stay, and reoperation rate in elective spine surgery. Spine J 19:261–266

    Article  Google Scholar 

  6. Hanada M, Nishikino S, Hotta K, Furuhashi H, Hoshino H, Matsuyama Y (2019) Intrawound vancomycin powder increases post-operative wound complications and does not decrease periprosthetic joint infection in primary total and unicompartmental knee arthroplasties. Knee Surg Sports Traumatol Arthrosc 27:2322–2327

    Article  Google Scholar 

  7. Hey HWD, Thiam DW, Koh ZSD et al (2017) Is intraoperative local vancomycin powder the answer to surgical site infections in spine surgery? Spine 42:267–274

    Article  Google Scholar 

  8. Horii C, Yamazaki T, Oka H et al (2018) Does intrawound vancomycin powder reduce surgical site infection after posterior instrumented spinal surgery? A propensity score-matched analysis. Spine J 18:2205–2212

    Article  Google Scholar 

  9. Kurtz SM, Lau E, Schmier J, Ong KL, Zhao KE, Parvizi J (2008) Infection burden for hip and knee arthroplasty in the United States. J Arthroplasty 23:984–991

    Article  Google Scholar 

  10. Kurtz SM, Ong KL, Schmier J et al (2007) Future clinical and economic impact of revision total hip and knee arthroplasty. J Bone Joint Surg Am 89:144–151

    Article  Google Scholar 

  11. Namba RS, Inacio MC, Paxton EW (2013) Risk factors associated with deep surgical site infections after primary total knee arthroplasty: an analysis of 56,216 knees. J Bone Joint Surg Am 95:775–782

    Article  Google Scholar 

  12. Paharik AE, Horswill AR (2016) The staphylococcal biofilm: adhesins, regulation and host response. Microbiol Spectr 4:1–27

    Article  CAS  Google Scholar 

  13. Parvizi J, Gehrke T, Chen AF (2013) Proceedings of the international consensus on periprosthetic joint infection. Bone Joint J 95-B:1450–1452

    Article  CAS  Google Scholar 

  14. 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 29:1449–1456

    Article  Google Scholar 

  15. Riesgo AM, Park BK, Herrero CP, Yu S, Schwarzkopf R, Iorio R (2018) Vancomycin povidone-iodine protocol improves survivorship of periprosthetic joint infection treated with irrigation and debridement. J Arthroplasty 33:847–850

    Article  Google Scholar 

  16. Thompson GH, Poe-Kochert C, Hardesty CK, Son-Hing J, Mistovich RJ (2018) Does vancomycin powder decrease surgical site infections in growing spine surgery? A preliminary study. J Bone Joint Surg Am 100:466–471

    Article  Google Scholar 

  17. 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 38:2149–2155

    Article  Google Scholar 

  18. Urquhart DM, Hanna FS, Brennan SL et al (2010) Incidence and risk factors for deep surgical site infection after primary total hip arthroplasty: a systematic review. J Arthroplasty 25:1216–1222

    Article  Google Scholar 

  19. Whiteside LA (2016) Prophylactic peri-operative local antibiotic irrigation. Bone Joint J 98-B:23–26

    Article  CAS  Google Scholar 

  20. Winkler C, Dennison J, Wooldridge A et al (2018) Do local antibiotics reduce periprosthetic joint infections? A retrospective review of 744 cases. J Clin Orthop Trauma 9:34–39

    Article  Google Scholar 

  21. Xiong L, Pan Q, Jin G, Xu Y, Hirche C (2014) Topical intrawound application of vancomycin powder in addition to intravenous administration of antibiotics: a meta-analysis on the deep infection after spinal surgeries. Orthop Traumatol Surg Res 100:785–789

    Article  CAS  Google Scholar 

  22. Zimmerli W, Trampuz A, Ochsner PE (2004) Prosthetic-joint infections. N Engl J Med 351:1645–1654

    Article  CAS  Google Scholar 

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Acknowledgements

We would like to thank Associate Professor Serdal Kenan Köse from the Ankara University Department of Biostatistics for his help with the statistical analysis.

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Correspondence to Ibrahim Alper Yavuz.

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The authors declare that they have no conflict of interest.

Funding

This study was not externally funded.

Ethical approval

The study was approved by the ethics committee of Ankara Numune Training and Research Hospital (No:2292).

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Yavuz, I.A., Oken, O.F., Yildirim, A.O. et al. No effect of vancomycin powder to prevent infection in primary total knee arthroplasty: a retrospective review of 976 cases. Knee Surg Sports Traumatol Arthrosc 28, 3055–3060 (2020). https://doi.org/10.1007/s00167-019-05778-8

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  • DOI: https://doi.org/10.1007/s00167-019-05778-8

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