Intrawound vancomycin powder in primary total knee arthroplasty: Does it reduce early postoperative infection?
Stephen A Doxey1, Torben H Urdahl2, Rafat H Solaiman2
1Department of Orthopaedic Surgery, TRIA Orthopaedic Institute, Bloomington, MN, USA; Department of Orthopaedic Surgery, Park Nicollet Methodist Hospital, St. Louis Park, MN, USA.
Background:
The purpose of this retrospective analysis of a prospective quality control project was to determine whether the use of intrawound vancomycin powder (IVP) decreases the rate prosthetic joint infection (PJI) within 90-days following primary total knee arthroplasty (TKA).
Methods:
From October 2021-September 2022, a prospective quality control project was undertaken in which 10 high-volume arthroplasty surgeons alternated between using IVP and not using IVP each month. Patients who received IVP were compared to those who did not. The primary outcome was culture positive PJI within 90-days following primary total knee arthroplasty. Secondary outcomes included overall reoperation rate, wound complications, and readmission within 90-days post-operatively.
Results:
A total of 1,317 primary TKA patients were identified for analysis. Fifty-six and seven tenths percent (n = 747) of patients were included in the IVP group and 43.3% (n = 570) patients were included in the non-IVP group. The overall PJI rate was 0.5%. There was no difference in 90-day culture positive PJI rates between the groups (0.7% vs. 0.2%, p = 0.24). The overall reoperation rate did not differ between the IVP and non-IVP group (6.4% vs. 4.6%, p = 0.15). Reoperation for suspected infection was not statistically different by IVP administration (1.2% vs. 0.5%, p = 0.25). Additionally, there were no differences in the incidence of wound complications (p = 0.80) or readmissions (p = 0.15).
Conclusions:
The overall infection rate for this cohort was low. IVP was not associated with decreased culture positive PJI, wound complications, reoperation or readmission rates. Further analysis of IVP use in TKA should be undertaken to fully determine its efficacy and safety profile.
Insights
Intrawound vancomycin powder (IVP) did not reduce prosthetic joint infection (PJI) rates within 90 days after primary total knee arthroplasty (TKA). This study found no significant difference in infection, reoperation, or complication rates between IVP and non-IVP groups.
Area of Science:
- Orthopedic Surgery
- Infectious Disease Prevention
- Pharmacology
Background:
- Prosthetic joint infection (PJI) is a significant complication following total knee arthroplasty (TKA).
- Intrawound vancomycin powder (IVP) is increasingly used to prevent PJI.
- Evidence on IVP efficacy in primary TKA remains under investigation.
Purpose of the Study:
- To evaluate the impact of intrawound vancomycin powder (IVP) on 90-day prosthetic joint infection (PJI) rates.
- To assess secondary outcomes including reoperation, wound complications, and readmission after primary TKA.
Main Methods:
- Retrospective analysis of a prospective quality control project (October 2021-September 2022).
- Comparison of 1,317 primary TKA patients: 747 in the IVP group and 570 in the non-IVP group.
- Surgeons alternated IVP use monthly; primary outcome was culture-positive PJI within 90 days.
Main Results:
- The overall PJI rate was low at 0.5%.
- No significant difference in 90-day culture-positive PJI rates between IVP (0.7%) and non-IVP (0.2%) groups (p=0.24).
- Similar rates for reoperation, wound complications, and readmissions were observed between groups.
Conclusions:
- Intrawound vancomycin powder (IVP) was not associated with a reduction in PJI, reoperation, or complication rates in primary TKA.
- The study highlights a low overall infection rate in the cohort.
- Further research is needed to fully establish the efficacy and safety profile of IVP in TKA procedures.
