Related Experiment Video
Updated: Jul 1, 2026
Knee Arthrocentesis in Adults
Published on: February 25, 2022
Intra-Articular Vancomycin Powder in Primary Total Knee Arthroplasty: A Retrospective Observational Study
Kemal Şibar1, Vedat Biçici2, Ezgi Gizem Şibar3
1Sultan 2. Abdülhamid Han Training and Research Hospital, Department of Orthopedics and Traumatology, İstanbul, Etlik City Hospital.
Background:
Periprosthetic joint infection (PJI) is one of the most serious complications following total knee arthroplasty (TKA). Vancomycin powder has been proposed as a low-cost adjunct to reduce infection by providing high local antibiotic concentrations with minimal systemic exposure; however, clinical evidence remains inconsistent. This study aimed to evaluate the effect of intra-articular vancomycin powder on PJI, aseptic wound complications, and renal function in primary TKA.
Materials And Methods:
Patients who underwent primary TKA between 2022 and 2024 with at least 1 year of follow-up were retrospectively analyzed. A total of 661 patients were included: 247 received 1 g intra-articular vancomycin powder and 414 served as controls. All procedures were performed with standardized perioperative protocols. Demographics, comorbidities, and high-risk status were recorded. Outcomes included PJI, aseptic wound complications, and acute kidney injury.
Results:
PJI occurred in 7 patients (1.1%): 6 in the control group (1.4%) and 1 in the vancomycin group (0.4%), with no significant difference (P = .266). Aseptic wound complications were observed in 28 patients (4.2%), including 20 control patients (4.8%) and 8 vancomycin patients (3.2%) (P = .326). Acute kidney injury occurred in 12 patients (1.8%), with comparable rates between groups (P = 1.000).
Conclusion:
Intra-articular vancomycin powder did not result in a statistically significant reduction in PJI rates, while demonstrating a favorable safety profile. Although safe, routine use may not provide additional measurable benefit in optimized surgical settings with low baseline infection rates. Larger, well-designed randomized trials are required to identify patient subgroups who may benefit from selective application.
Insights
Intra-articular vancomycin powder did not significantly reduce periprosthetic joint infection (PJI) after total knee arthroplasty (TKA). While safe, its routine use may not offer additional benefits in low-infection-rate settings.
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.
