Efficacy and safety of intrawound vancomycin in primary hip and knee arthroplasty

Abstract

Aims The efficacy and safety of intrawound vancomycin for preventing surgical site infection in primary hip and knee arthroplasty is uncertain. Methods A systematic review of the literature was conducted, indexed from inception to March 2020 in PubMed, Web of Science, Cochrane Library, Embase, and Google Scholar databases. All studies evaluating the efficacy and/or safety of intrawound vancomycin in patients who underwent primary hip and knee arthroplasty were included. Incidence of periprosthetic joint infection (PJI), superficial infection, aseptic wound complications, acute kidney injury, anaphylactic reaction, and ototoxicity were meta-analyzed. Results were reported as odds ratios (ORs) and 95% confidence intervals (CIs). The quality of included studies was assessed using the risk of bias in non-randomized studies of interventions (ROBINS-I) assessment tool. Results Nine studies involving 4,607 patients were included. Intrawound vancomycin was associated with lower incidence of PJI (30 patients (1.20%) vs 58 control patients (2.75%); OR 0.44, 95% CI 0.28 to 0.69) and simultaneous acute kidney injury (four patients (0.28%) vs four control patients (0.35%), OR 0.71, 95% CI 0.19 to 2.55). However, it did not reduce risk of superficial infection (four patients (0.67%) vs six control patients (1.60%), OR 0.60, 95% CI 0.17 to 2.12) and was associated with higher incidence of aseptic wound complications (23 patients (2.15%) vs eight in control patients (0.96%), OR 2.39, 95% CI 1.09 to 5.23). Four studies reported no anaphylactic reactions and three studies reported no ototoxicity in any patient group. Conclusion The current literature suggests that intrawound vancomycin used in primary hip and knee arthroplasty may reduce incidence of PJI, but it may also increase risk of aseptic wound complications. Cite this article: Bone Joint Res 2020;9(11):778–788.

Animal experimental investigation on the efficacy of antibiotic therapy with linezolid, vancomycin, cotrimoxazole, and rifampin in treatment of periprosthetic knee joint infections by MRSA

“…This result supports the findings of a systematic review of the literature from 2020, which included 4,607 patients. 23 In primary knee arthroplasty, intrawound vancomycin reduces the incidence of PJI, but it may increase the risks of aseptic wound complications. For this reason, we opted for intraperitoneal application.…”

Intra-articular versus systemic vancomycin for the treatment of periprosthetic joint infection after debridement and spacer implantation in a rat model

“…Thus, local vancomycin injections could maintain high drug concentrations in the infected tissues, reducing systemic adverse effects, which might represent a more effective and safe strategy for PJI control. 48 Orthopaedic surgeons have previously attempted to apply vancomycin in PJI cases caused by S. aureus or MRSA to control the infections after one-stage revision arthroplasty, either intra-articularly or systematically. The treatment duration often lasts for six weeks or more.…”

Effects of different doses of vancomycin powder in total knee and hip arthroplasty on the periprosthetic joint infection rate: a systematic review and meta-analysis

“…Vancomycin powder in joint arthroplasty surgery has been used only in recent years, and the effect of reducing the postoperative PJI rate is still unclear. According to the results of some previously published meta-analyses [ 39 – 41 ], the use of vancomycin powder has a significant effect on reducing the postoperative PJI rate. However, we believe that the published meta-analyses are not comprehensive and have not considered the effects of different surgical sites, different surgery types, and different vancomycin powder doses on the PJI rate.…”