Intra-Articular Vancomycin Powder in Primary Total Knee Arthroplasty: A Retrospective Observational Study

Area of Science:

• Orthopedics
• Infectious Disease
• Surgical Innovation

Background:

• Periprosthetic joint infection (PJI) is a severe complication of total knee arthroplasty (TKA).
• Vancomycin powder is explored for its potential to reduce TKA infections via high local concentrations.
• Clinical evidence on vancomycin powder's efficacy in TKA remains inconsistent.

Purpose of the Study:

• To evaluate the impact of intra-articular vancomycin powder on PJI rates in primary TKA.
• To assess the effect on aseptic wound complications and renal function post-TKA.
• To determine the safety and efficacy of vancomycin powder as an adjunct in TKA procedures.

Main Methods:

• Retrospective analysis of 661 primary TKA patients (2022-2024) with ≥1 year follow-up.
• Comparison between 247 patients receiving intra-articular vancomycin powder and 414 controls.
• Outcomes measured: PJI, aseptic wound complications, and acute kidney injury.

Main Results:

• PJI occurred in 0.4% of vancomycin patients vs. 1.4% of controls (P=.266).
• Aseptic wound complications were observed in 3.2% of vancomycin patients vs. 4.8% of controls (P=.326).
• Acute kidney injury rates were comparable between groups (P=1.000).

Conclusions:

• Intra-articular vancomycin powder did not significantly reduce PJI rates in primary TKA.
• The intervention demonstrated a favorable safety profile with no increased risk of complications.
• Routine use may not be beneficial in optimized surgical settings; further trials are needed for selective application.