Use of vancomycin powder under polyethylene in total knee arthroplasty: a technical note

Periprosthetic joint infections (PJI) remain a significant complication in total knee arthroplasty (TKA), often necessitating complex revisions. Vancomycin powder has been used intra-articularly to reduce PJI rates, but conflicting evidence suggests potential complications. This technical note introduces a novel approach: applying vancomycin powder beneath the polyethylene component during TKA, rather than directly into the joint space. We hypothesize that this technique could enhance infection prevention efficacy while minimizing complications associated with intra-articular vancomycin. We detail the indications, procedural steps, and potential complications of this method. Vancomycin powder is applied to the tibial surface before inserting the polyethylene component, maintaining the drug's proximity to potential infection sites without direct exposure to joint tissues. This approach aims to balance infection prevention with safety concerns, providing an alternative for patients at high risk for PJI. Further clinical validation is necessary to confirm the efficacy and safety of this technique.