Effectiveness of Intra-Articular Injection of Ceftazidime/Vancomycin Combination during Total Knee Replacement: Prevention of Periprosthetic Joint Infection

Abstract

Background:The occurrence of prosthetic joint infection (PJI) subsequent to total knee arthroplasty (TKA), also known as total knee replacement, is a highly detrimental complication. Some studies have concluded that intra-articular antibiotic injection was an effective approach to prevention of PJI, while others have reached the opposite conclusion. However, there is no study performed in one center, by one surgeon, one surgical team, or one type of prosthetic device.Methods: This was a historical cohort study on patients who underwent primary TKA with vancomycin and ceftazidime (652 cases from September 2019 to the end of December 2020) and were compared with a cohort of patients also treated with TKA but without using antibiotic injection (620 controls from March 2018 to the end of August 2019). The incidence of PJI was followed for two years in each group by chart review.Results: Study groups were matched for age (P-value 0.193), gender (P-value 0.913), body mass index (BMI) (P-value 0.136), and radiologic features of their knees (P-value > 0.05). Prosthetic joint infection was developed by only three patients: one (0.18%) in the case group and the remaining two (0.32%) in the control group (P-value 0.615); all three patients had a positive response to the treatment which included debridement, antibiotics, implant retention (DAIR) surgery and a course of antibiotics.Conclusion: To our knowledge, this is the most precisely matched cohort of TKA subjects in this era. Intra-articular injection of vancomycin and ceftazidime during TKA showed no significant difference in reducing the risk of PJI in the case group. However, although PJI is a rare event in joint replacement surgery, it should be prospectively investigated in a study with even larger sample sizes.