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Published on: March 14, 2019
Intraosseous Vancomycin May Not Be Helpful in Aseptic Revision Knee Arthroplasty: A Single-Surgeon Consecutive Case
1Department of Surgery, Durham Veteran's Administration Medical Center, Durham, North Carolina; Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina.
Background:
Infection after aseptic revision total knee arthroplasty (TKA) has been reported from 9% to 14%. Intraosseous (IO) vancomycin infusion has decreased the risk of infection after primary TKA. The results of this additional prophylaxis were evaluated in aseptic revision TKA.
Methods:
In this prospective, single-surgeon study of 20 consecutive patients having aseptic revision TKA, 500 milligrams of vancomycin in 120 mL of saline were infused into the tibia prior to incision, in addition to intravenous (IV) cefazolin. There were 18 men and 2 women who had a mean age of 67 years (range, 47-79), and mean body mass index of 34.4 (range, 25.9-51.2). The knees were aspirated in the operating room prior to IV and IO antibiotics. The outcomes were infections at 90 days requiring reoperation and complications from the infusion.
Results:
Three of the 20 aseptic revisions had early prosthetic joint infection, 2 with gram-negative organisms and one with coagulase-negative Staphylococcus. All had debridement, liner exchange and IV antibiotic treatment, but 1 patient eventually had an above knee amputation. No patient had total body "erythema syndrome", but 1 patient had transient facial flushing. Six patients had a transient elevation of serum creatinine including 3 with an abnormal preoperative serum creatinine.
Conclusion:
In this small series of aseptic revision TKA, there was no added benefit of IO vancomycin infusion, but there were no infections with methicillin-resistant Staphylococcus aureus. Additional studies are needed before this technique should be routinely recommended.
Insights
Intraosseous vancomycin infusion did not reduce infection rates in aseptic revision total knee arthroplasty (TKA). While no methicillin-resistant Staphylococcus aureus infections occurred, further research is needed to assess this prophylaxis.
Area of Science:
- Orthopedic Surgery
- Infectious Disease
- Pharmacology
Background:
- Infection rates after aseptic revision total knee arthroplasty (TKA) range from 9% to 14%.
- Intraosseous (IO) vancomycin infusion has previously shown promise in reducing infection risk for primary TKA.
- The efficacy of IO vancomycin as an additional prophylactic measure in aseptic revision TKA requires evaluation.
Purpose of the Study:
- To evaluate the effectiveness of intraosseous (IO) vancomycin infusion as an additional prophylactic measure in patients undergoing aseptic revision total knee arthroplasty (TKA).
Main Methods:
- A prospective, single-surgeon study involving 20 consecutive patients undergoing aseptic revision TKA.
- Intraosseous (IO) vancomycin (500 mg in 120 mL saline) was infused into the tibia prior to incision, alongside intravenous (IV) cefazolin.
- Knee aspirations were performed pre-antibiotics, and outcomes included 90-day infections requiring reoperation and infusion-related complications.
Main Results:
- Three out of 20 aseptic revisions (15%) developed early prosthetic joint infection (2 gram-negative, 1 coagulase-negative Staphylococcus).
- One patient required an above-knee amputation; another experienced transient facial flushing.
- Six patients had transient elevations in serum creatinine, including three with pre-existing abnormal levels.
Conclusions:
- Intraosseous (IO) vancomycin infusion did not demonstrate added benefit in preventing infections in this small series of aseptic revision TKA.
- No infections with methicillin-resistant Staphylococcus aureus were observed.
- Further studies are necessary to determine if this technique should be routinely recommended for aseptic revision TKA.
