Serum and Wound Vancomycin Levels After Intrawound Administration in Primary Total Joint Arthroplasty

Area of Science:

• Orthopedic Surgery
• Infectious Disease
• Pharmacokinetics

Background:

• Periprosthetic joint infection is a leading cause of readmission after total joint arthroplasty (TJA).
• Intrawound vancomycin powder (VP) is effective in reducing infection rates in spinal surgery.
• Limited data exist on VP's efficacy and safety in primary TJA.

Purpose of the Study:

• To investigate the pharmacokinetics of intraoperative VP in patients undergoing primary TJA.
• To determine serum and wound concentrations of VP over 24 hours postoperatively.
• To assess the potential of VP as an adjunct for preventing periprosthetic joint infection.

Main Methods:

• A prospective study involving 34 TJA patients.
• Administration of 2 g of VP intraoperatively.
• Measurement of serum and wound VP concentrations at multiple time points up to 24 hours.

Main Results:

• Serum VP concentrations remained subtherapeutic (<15μg/mL) throughout the study period.
• Peak serum concentration was 4.7μg/mL at 12 hours post-closure.
• Wound VP concentrations were high, measuring 922 μg/mL at 3 hours and 207 μg/mL at 24 hours.
• VP exhibited a half-life of 7.2 hours within TJA wounds.

Conclusions:

• Intraoperative VP in TJA yields therapeutic intrawound concentrations.
• Systemic absorption of VP was minimal, suggesting a favorable safety profile.
• VP may be a valuable adjunct in preventing periprosthetic joint infections in TJA.