Decrease in acute periprosthetic joint infections incidence with vancomycin-loaded calcium sulfate beads in patients...

Area of Science:

• Orthopedic Surgery
• Infectious Disease Prevention
• Biomaterials in Medicine

Background:

• The efficacy of local antibiotic prophylaxis in preventing periprosthetic joint infections (PJI) after orthopedic surgery, particularly in patients with non-modifiable risk factors, remains an area requiring further investigation.
• Conventional intravenous (IV) antibiotic prophylaxis is standard, but local delivery methods may offer enhanced protection and reduced systemic exposure.

Purpose of the Study:

• To compare the incidence of PJI in patients undergoing total hip or knee replacement with non-modifiable risk factors, utilizing local vancomycin-loaded calcium sulfate beads versus standard IV antibiotic prophylaxis.
• To evaluate the effectiveness of local antibiotic delivery in reducing PJI rates in a high-risk orthopedic patient population.

Main Methods:

• A randomized trial involving 83 patients over 60 with at least one major PJI risk factor undergoing hip or knee replacement.
• The intervention group received vancomycin-impregnated calcium sulfate beads locally, while the control group received conventional IV antibiotic prophylaxis.
• Biomarkers (CRP, ERS) and synovial fluid cultures were used for PJI diagnosis and monitoring.

Main Results:

• A significantly lower incidence of acute PJI was observed in the intervention group (9.3%) compared to the control group (67.5%), with a relative risk of 0.13 (p < 0.0001).
• The local antibiotic prophylaxis group experienced a shorter hospital stay (4.6 days) compared to the control group (15.25 days) (p < 0.001).

Conclusions:

• Local antibiotic prophylaxis with vancomycin-loaded calcium sulfate beads is a highly effective strategy for reducing acute PJI incidence in high-risk orthopedic surgery patients.
• This localized approach offers a significant advantage over conventional IV antibiotics, leading to improved patient outcomes and reduced healthcare resource utilization.