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Published on: December 3, 2017
Systematic Review and Meta-Analysis of Intrawound Vancomycin in Total Hip and Total Knee Arthroplasty: A Continued
Kamran Movassaghi1, Jennifer C Wang2, Brandon S Gettleman3
1Department of Orthopaedic Surgery, University of California San Francisco, Fresno, California.
Background:
Periprosthetic joint injection (PJI) is a rare, but life-altering complication of total joint arthroplasty (TJA). Though intrawound vancomycin powder (IVP) has been studied in other orthopedic subspecialties, its efficacy and safety in TJA has not been established.
Methods:
PubMed and MEDLINE databases were used to identify studies utilizing IVP in primary and revision total hip (THA) and knee arthroplasty (TKA). Postoperative PJI data were pooled using random effect models with results reported as odds ratios (ORs) and 95% confidence intervals (CIs). Studies were weighted by the inverse variance of their effect estimates.
Results:
Overall, 16 of the 1871 studies identified were pooled for final analysis, yielding 33,731 patients totally. Of these, 17 164 received IVP. In aggregate, patients who received IVP had a decreased rate of PJI (OR 0.46, P < .05). Separately, TKA and THA patients who received IVP had lower rates of PJI (OR 0.41, P < .05 and OR 0.45, P < .05, respectively). Aggregate analysis of primary TKA and THA patients also revealed a decreased PJI rate (OR 0.44, P < .05). Pooled revision TKA and THA patients had a similar decrease in PJI rates (OR 0.30, P < .05). Although no publication bias was appreciated, these findings are limited by the low-quality evidence available.
Conclusion:
While IVP may reduce the risk of PJI in primary and revision TJA, its widespread use cannot be recommended until higher-quality data, such as that obtained from randomized control trials, are available. This study underscores the continued need for more rigorous studies before general adoption of this practice by arthroplasty surgeons.
Insights
Intrawound vancomycin powder may reduce periprosthetic joint infection (PJI) after total joint arthroplasty (TJA). However, more high-quality evidence is needed before widespread adoption by surgeons.
Area of Science:
- Orthopedic Surgery
- Infectious Disease Prevention
- Arthroplasty Complications
Background:
- Periprosthetic joint infection (PJI) is a serious complication following total joint arthroplasty (TJA).
- Intrawound vancomycin powder (IVP) is used in other orthopedic procedures, but its role in TJA is not well-established.
Purpose of the Study:
- To evaluate the efficacy of intrawound vancomycin powder (IVP) in reducing PJI rates in total joint arthroplasty (TJA).
- To analyze IVP's impact on both primary and revision hip and knee arthroplasty procedures.
Main Methods:
- A systematic literature search of PubMed and MEDLINE identified relevant studies on IVP in TJA.
- Random-effects models were used to pool postoperative PJI data, reporting odds ratios (ORs) and 95% confidence intervals (CIs).
- Studies were weighted by the inverse variance of their effect estimates.
Main Results:
- Analysis of 16 studies (33,731 patients) showed IVP significantly decreased PJI rates in aggregate (OR 0.46).
- IVP reduced PJI in both total knee arthroplasty (TKA) (OR 0.41) and total hip arthroplasty (THA) (OR 0.45), including primary and revision cases.
- No publication bias was detected, but the evidence quality was low.
Conclusions:
- Intrawound vancomycin powder may lower the risk of PJI in primary and revision TJA.
- Widespread adoption is not recommended due to the low-quality evidence.
- Further high-quality studies, such as randomized controlled trials, are necessary.
