Local Vancomycin Application Reduces Periprosthetic Joint Infections in Oncologic Megaprosthetic Reconstruction: A...

Area of Science:

• Orthopedic Surgery
• Oncology
• Infectious Diseases
• Pharmacology

Background:

• Periprosthetic joint infections (PJIs) are a severe complication after musculoskeletal tumor resection and megaprosthetic reconstruction.
• Local antibiotic administration can achieve high drug concentrations, potentially reducing infection risk.

Purpose of the Study:

• To evaluate the efficacy of local vancomycin powder in reducing postoperative PJIs in bone tumor surgeries involving megaprostheses.

Main Methods:

• Retrospective cohort study of 276 patients undergoing bone tumor resection and megaprosthetic reconstruction.
• Two groups: control (standard intravenous antibiotics) and vancomycin (additional 1g local vancomycin powder at closure).
• PJIs monitored for 2 years using 2018 ICM criteria; multivariable competing risks regression analysis performed.

Main Results:

• PJIs occurred in 19.7% of the control group vs. 5.9% in the vancomycin group (p=0.001).
• Local vancomycin significantly lowered infection risk (HR: 0.40, 95% CI: 0.16-0.95, p=0.040).
• Pelvic tumors were associated with increased infection risk (HR: 5.82, p<0.001).

Conclusions:

• Local vancomycin powder appears to reduce PJI rates in oncologic megaprosthetic reconstruction without increasing complications.
• Further randomized studies are needed to confirm efficacy and optimize vancomycin dosing strategies.