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[Intraosseous vancomycin in total knee arthroplasty]
W F Martínez1, F Tillet2, E J Bochatey3
1Pontificia Universidad Católica Argentina, Facultad de Medicina. Buenos Aires, Argentina; Grupo GRECARO.
Introduction:
intravenous antibiotic prophylaxis has significantly reduced the incidence of periprosthetic joint infection (PJI) in knee surgeries. However, for patients colonized with methicillin-resistant Staphylococcus aureus (MRSA) or those at risk of colonization, prophylaxis should include vancomycin. Intraosseous (IO) administration of vancomycin could enhance its effectiveness in total knee arthroplasty (TKA).
Material And Methods:
a retrospective review was conducted, including 143 patients at risk of PJI scheduled for TKA who received IO vancomycin along with intravenous (IV) cefazolin, referred to as group I (GI), between May 2021 and December 2022. The occurrence of complications in the first three postoperative months was evaluated. Results were compared with 140 patients without risk factors who received standard IV prophylaxis, designated as group II (GII).
Results:
in GI, 500 mg of IO vancomycin was administered, injected into the proximal tibia, in addition to standard IV prophylaxis. In GII, patients received only IV cefazolin. The incidence of complications was 1.64% in GI and 1.4% in GII. The PJI rate at 90 postoperative days was 0.69% in GI and 0.71% in GII.
Conclusions:
IO vancomycin administration, along with standard IV prophylaxis, provides a safe and effective alternative for patients at risk of MRSA colonization. This approach minimizes complications associated with IV vancomycin use and addresses logistical challenges of timely administration.
Insights
Intraosseous vancomycin in knee replacement surgery is safe and effective for patients at risk of MRSA. This method reduces complications compared to standard intravenous vancomycin, improving outcomes in total knee arthroplasty.
Area of Science:
- Orthopedic Surgery
- Infectious Disease
- Pharmacology
Context:
- Periprosthetic joint infection (PJI) is a significant risk in total knee arthroplasty (TKA).
- Methicillin-resistant Staphylococcus aureus (MRSA) colonization increases PJI risk.
- Intravenous (IV) vancomycin is used for MRSA prophylaxis but has limitations.
Purpose:
- To evaluate the safety and efficacy of intraosseous (IO) vancomycin for PJI prophylaxis in TKA patients at risk for MRSA.
- To compare complication rates and PJI incidence between IO vancomycin and standard IV prophylaxis.
Summary:
- A retrospective review compared 143 TKA patients receiving IO vancomycin with IV cefazolin (Group I) to 140 patients receiving standard IV cefazolin (Group II).
- Group I received 500 mg IO vancomycin in the proximal tibia.
- Complication rates were 1.64% in Group I and 1.4% in Group II; 90-day PJI rates were 0.69% and 0.71%, respectively.
Impact:
- IO vancomycin offers a safe and effective alternative for MRSA-colonized patients undergoing TKA.
- This method potentially reduces complications associated with IV vancomycin.
- Addresses logistical challenges in administering vancomycin prophylaxis.
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