Only a partial shield: local vancomycin postpones but does not prevent hip and knee prosthetic infections

Periprosthetic joint infection (PJI) represents a severe complication following total hip arthroplasty (THA) and total knee arthroplasty (TKA). The intraarticular application of vancomycin powder is increasingly integrated into perioperative standards as an innovative strategy for PJI prevention. Yet the efficacy of this method remains a topic of debate. The aim of this retrospective cohort study was to evaluate whether topical vancomycin application reduces the incidence of PJI after primary total joint arthroplasty (TJA) and whether it is associated with an increased risk of wound complications.

In this retrospective monocentric cohort study, all primary THA and TKA procedures performed between January 1, 2022, and December 31, 2023, were analysed. From January 1, 2023, intraarticular vancomycin powder was implemented as part of the standard perioperative protocol for PJI prevention. The PJI rates, postoperative surgery-related complications, and time to infection were compared between the vancomycin and control groups.

A total of 1,499 patients were included in the study. Patients were divided into two groups: a vancomycin group (VG, n = 818) and a control group (CG, n = 681). No statistically significant group differences were observed for wound healing disorders (p = 0.775) or PJI rates (1.0% VG vs. 0.9% CG, p = 0.846). However, there was a statistically significant delay in the onset of infection in the VG compared to the CG (41.5 vs. 16.5 days, p = 0.006).

Intraarticular application of vancomycin powder was not associated with a reduction in overall PJI rates after primary TJA but appeared to be associated with a longer time to infection. These findings may suggest that local vancomycin application delays the clinical manifestation of infection rather than preventing it, potentially complicating the diagnosis of PJI and limiting less invasive treatment options.