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Complications of intraosseous administration of vancomycin in total hip arthroplasty
W F Martínez1, L Camacho Terceros2, F Garbini2
1Facultad de Medicina, Pontificia Universidad Católica Argentina, Buenos Aires, Argentina; Clínica Privada Hispano Argentina, Buenos Aires, Argentina; Grupo GRECARO, Ciudad Autónoma de Buenos Aires, Argentina.
Introduction:
The incidence of periprosthetic joint infection (PJI) in hip surgeries has significantly decreased thanks to intravenous (IV) antibiotic prophylaxis. However, in patients colonized with methicillin-resistant Staphylococcus aureus (MRSA) or those at risk of colonization, it is necessary to include vancomycin in the prophylaxis. Intraosseous administration of vancomycin could enhance its effectiveness in total hip arthroplasty (THA).
Materials And Methods:
A retrospective study was conducted between March and December 2023 involving 53 patients scheduled for primary THA with colonization risk factors. The median age of the patients was 67 years (range 61 to 75), and all received treatment with intraosseous vancomycin (500mg). Detailed records and documentation of complications during hospitalization and the first three months post-surgery were maintained. As a secondary outcome measure, the incidence of PJI was explored.
Results:
We administered 500mg of intraosseous vancomycin, injected into the greater trochanter, along with standard IV prophylaxis. The incidence of complications was 1.64%. The PJI rate at 90 days was 0%.
Conclusions:
Intraosseous administration of low-dose vancomycin in THA for patients at risk of MRSA colonization, combined with standard IV prophylaxis, was shown to be safe and did not present significant adverse effects. Furthermore, this strategy eliminates the logistical challenges associated with timely vancomycin administration.
Level Of Evidence Iv:
Case Series.
Insights
Intraosseous vancomycin in total hip arthroplasty (THA) for MRSA-colonized patients is safe and effective. This method reduced periprosthetic joint infection (PJI) to 0% and simplified vancomycin delivery.
Area of Science:
- Orthopedic Surgery
- Infectious Disease
- Pharmacology
Background:
- Intravenous antibiotic prophylaxis has reduced periprosthetic joint infection (PJI) rates in hip surgeries.
- Patients colonized with methicillin-resistant Staphylococcus aureus (MRSA) require vancomycin prophylaxis.
- Intraosseous vancomycin may improve efficacy in total hip arthroplasty (THA).
Purpose of the Study:
- To evaluate the safety and efficacy of intraosseous vancomycin administration in primary THA patients at risk for MRSA colonization.
- To assess the incidence of complications and PJI following intraosseous vancomycin prophylaxis.
Main Methods:
- Retrospective case series of 53 patients undergoing primary THA (March-December 2023).
- Patients received 500mg intraosseous vancomycin into the greater trochanter plus standard IV prophylaxis.
- Complications and PJI rates were monitored during hospitalization and for three months post-surgery.
Main Results:
- A low complication incidence of 1.64% was observed.
- The 90-day periprosthetic joint infection (PJI) rate was 0%.
- No significant adverse effects were reported.
Conclusions:
- Intraosseous vancomycin is a safe and effective prophylactic strategy for THA patients at risk of MRSA colonization.
- This method eliminates logistical challenges of timely vancomycin administration.
- The 0% PJI rate suggests high efficacy in preventing infection.
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