Intraoperative Vancomycin Does Not Change Periprosthetic Joint Infection Risk in Patients Undergoing Total Joint...

Area of Science:

• Orthopedic Surgery
• Infectious Disease
• Pharmacology

Background:

• Cephalosporins are standard prophylaxis for primary total hip (THA) and knee (TKA) arthroplasty.
• Intraoperative vancomycin is explored to augment antibiotic prophylaxis, but evidence is limited by small study sizes and low infection rates.
• This study evaluates the impact of intraoperative vancomycin on short-term complications and long-term outcomes in a large national cohort.

Purpose of the Study:

• To compare 90-day infectious and medical complications between patients receiving cefazolin alone versus cefazolin with intraoperative vancomycin during primary THA and TKA.
• To assess 5-year revision-free survival in patients who received intraoperative vancomycin compared to those who did not.
• To determine if intraoperative vancomycin provides additional benefit beyond standard cefazolin prophylaxis in preventing periprosthetic joint infections (PJI).

Main Methods:

• A retrospective analysis of a national database identified adult patients undergoing primary THA or TKA for osteoarthritis.
• Patients receiving cefazolin prophylaxis were matched 1:1 based on multiple demographic and clinical factors, comparing those who did and did not receive intraoperative vancomycin.
• Outcomes including 90-day complications and 5-year revision-free survival were analyzed using logistic regression and Kaplan-Meier survival analysis, respectively.

Main Results:

• Intraoperative vancomycin was not associated with a reduction in 90-day odds of superficial surgical site infection or PJI for either THA or TKA.
• No significant increase in other adverse medical events was observed with the addition of vancomycin.
• Five-year revision-free survival rates were comparable between the vancomycin and no-vancomycin groups for both THA and TKA.

Conclusions:

• In this large national cohort, intraoperative vancomycin added to cefazolin prophylaxis did not improve outcomes for primary total hip or knee arthroplasty.
• The addition of vancomycin did not reduce the risk of 90-day surgical site infections or PJI.
• Intraoperative vancomycin did not enhance 5-year revision-free survival in patients undergoing primary THA or TKA.