No effect of vancomycin powder to prevent infection in primary total knee arthroplasty: a retrospective review of 976 ca
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KNEE
No effect of vancomycin powder to prevent infection in primary total knee arthroplasty: a retrospective review of 976 cases Ibrahim Alper Yavuz1 · Ozdamar Fuad Oken1 · Ahmet Ozgur Yildirim1 · Fatih Inci1 · Erman Ceyhan1 · Utku Gurhan1 Received: 23 July 2019 / Accepted: 28 October 2019 © European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019
Abstract Purpose Vancomycin powder (VP) has been used to prevent periprosthetic joint infection (PJI). However, studies investigating the efficacy of VP to prevent infection in primary total knee arthroplasty (TKA) are very rare. The purpose of this study was to investigate the efficacy of VP application to prevent PJI in TKA. Methods Between 2012 and 2016, 976 consecutive patients who underwent primary TKA were included in the present study. Patients were divided into two groups. There were 474 patients (48.6%) in the VP group and 502 patients in the control group (51.4%). Except for VP, all procedures were the same in both groups. In the VP group, 2 g of VP was poured into the joint just before the fascia was closed. Average follow-up was 53.2 months (24–84 months). Results Infection was found in 4 (0.84%) of 474 patients in the VP group and 5 (0.99%) of 502 patients in the control group. There was no statistically significant difference between groups in terms of infection rates (p = 0.535). Staphylococcus aureus was found in 2 patients in the VP group. Two patients had S. aureus and 1 patient had Pseudomonas aeruginosa in the control group. There was no statistically significant difference between groups in terms of demographic parameters (p > 0.05). Conclusion Intrawound VP administration doesn’t change the infection rates in primary TKA. The VP administration for preventing PJI is not recommended in primary TKA. Level of evidence III. Keywords Local vancomycin powder · Primary total knee arthroplasty · Total knee replacement · Periprosthetic joint infection
Introduction
* Ibrahim Alper Yavuz [email protected] Ozdamar Fuad Oken [email protected] Ahmet Ozgur Yildirim [email protected] Fatih Inci [email protected] Erman Ceyhan [email protected] Utku Gurhan [email protected] 1
Department of Orthopaedics and Traumatology, University of Health Science, Ankara Numune Training and Research Hospital, Ankara, Turkey
Periprosthetic joint infections (PJIs) are not seen very often. However, the increasing incidence of arthroplasty is a challenging and costly issue [9, 10]. Recent studies have shown that the prevalence of PJI is 2% after TKA and 5.6% after revision TKA [11, 18]. Perioperative intravenous (iv) antibiotic prophylaxis has effectively reduced infection rates in major joint arthroplasty but surgeons started to use extra antibiotic and/or anti-infective solutions during surgery for more reducing the PJIs. As seen in the orthopaedic literature, in orthopaedic spine and trauma surgery there is a particular trend towards increased usage of local antibiotics [2, 7, 16, 21]. In local administration, vancomyc
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