Intrawound vancomycin powder increases post-operative wound complications and does not decrease periprosthetic joint...

Area of Science:

• Orthopedic Surgery
• Infectious Disease Prevention
• Arthroplasty Research

Background:

• Periprosthetic joint infection (PJI) is a common cause of revision surgery after total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA).
• The effectiveness of intrawound vancomycin (VP) in preventing PJI after primary knee arthroplasty is not well-documented.

Purpose of the Study:

• To evaluate the efficacy of local high-dose intrawound vancomycin (VP) in preventing PJI after primary TKA and UKA.
• To assess the incidence of aseptic wound complications associated with intrawound VP application.

Main Methods:

• A comparative study involving 166 patients undergoing primary TKA or UKA from 2010 to 2017.
• A control group (75 patients) received no VP, while the VP group (90 patients) received 1g of intrawound VP before capsule closure.
• Post-operative evaluation included aseptic wound complications within 3 months and PJI assessment within 1 year.

Main Results:

• Periprosthetic joint infection (PJI) rates were 7.6% in the control group and 4.5% in the VP group, with no significant difference.
• Aseptic operative wound complications were more frequent in the VP group (11.8%) compared to the control group (4.3%).
• Prolonged wound healing also occurred more frequently in the VP group (12.7%) versus the control group (3.3%).

Conclusions:

• Intrawound vancomycin (VP) administration does not reduce PJI occurrence in primary total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA).
• The use of intrawound VP is associated with a significant increase in aseptic wound complications.
• Intrawound VP is not recommended for preventing PJI in primary TKA and UKA procedures.