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[Translated article] 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 colonised with methicillin-resistant Staphylococcus aureus (MRSA) or those at risk of colonisation, 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 colonisation risk factors. The median age of the patients was 67 years (range 61-75), and all received treatment with intraosseous vancomycin (500mg). Detailed records and documentation of complications during hospitalisation 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 colonisation, 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) is safe for patients at risk of methicillin-resistant Staphylococcus aureus (MRSA) colonization, showing a 0% periprosthetic joint infection (PJI) rate and fewer logistical issues.
Area of Science:
- Orthopedic Surgery
- Infectious Disease Prevention
- Pharmacology
Background:
- Intravenous antibiotic prophylaxis has reduced periprosthetic joint infection (PJI) rates in hip surgeries.
- Vancomycin is crucial for patients colonized with methicillin-resistant Staphylococcus aureus (MRSA) or at high risk.
- Intraosseous vancomycin delivery 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 between March and December 2023.
- Patients received 500mg of intraosseous vancomycin into the greater trochanter, alongside standard IV prophylaxis.
- Complications and PJI rates were monitored during hospitalization and for three months post-surgery.
Main Results:
- A total of 500mg intraosseous vancomycin was administered per patient.
- The overall complication incidence was 1.64%.
- No cases of PJI were reported at the 90-day follow-up.
Conclusions:
- Intraosseous vancomycin, combined with standard IV prophylaxis, is a safe adjunctive treatment for THA patients at risk of MRSA colonization.
- This method demonstrated no significant adverse effects and achieved a 0% PJI rate at 90 days.
- Intraosseous delivery simplifies vancomycin administration logistics.
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