Vancomycin Powder and Dilute Povidone-Iodine Lavage for Infection Prophylaxis in High-Risk Total Joint Arthroplasty

Iorio, Richard; Yu, Stephen; Anoushiravani, Afshin A.; Riesgo, Aldo M.; Park, Brian; Vigdorchik, Jonathan M.; Slover, James; Long, William J.; Schwarzkopf, Ran

doi:10.1016/j.arth.2020.02.060

Cited by 50 publications

(32 citation statements)

References 20 publications

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“…Iorio et al recently retrospectively studied the effects of a "vanco-povidone protocol" in which high-risk patients undergoing total hip or total knee arthroplasty received a diluted povidone-iodine lavage following implantation and 2 g of vancomycin powder in the wound during closure. They found a 27.8% reduction in PJI in patients who received their povidone-iodine/vancomycin powder protocol without medical complications or increase in vancomycin-resistant organisms [77]. Vancomycin powder has also been shown to reduce surgical site infection in the spine literature [78].…”

Section: Intra-operative Prophylaxismentioning

confidence: 99%

Periprosthetic Infection After Reverse Shoulder Arthroplasty: a Review

Contreras

Frantz

Bishop

et al. 2020

Curr Rev Musculoskelet Med

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Purpose of Review Periprosthetic infection is a relatively rare but potentially devastating complication after shoulder arthroplasty. The purpose of this article is to review the incidence, diagnosis, prevention, and management of periprosthetic infections after reverse shoulder arthroplasty, with a focus on literature published within the last 5 years. Recent Findings The 2018 International Consensus Meeting on Musculoskeletal Infection provides us with a framework for the diagnosis and management of periprosthetic infections after shoulder arthroplasty. Reverse shoulder arthroplasty has a higher reported rate of infection compared with anatomic total shoulder arthroplasty. Our current diagnostic tests do not appear to be as sensitive when compared with the hip and knee literature. Similar success has been reported with single and two-stage revision protocols, although prospective comparative data are lacking. The significance of unexpected positive cultures during revision arthroplasty remains unclear. Summary We report current diagnostic and therapeutic options for periprosthetic infection after reverse shoulder arthroplasty. Much of the current literature does not distinguish between anatomic and reverse shoulder arthroplasty. Further high-level studies are warranted to refine these definitions and guide management.

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Section: Intra-operative Prophylaxismentioning

confidence: 99%

Periprosthetic Infection After Reverse Shoulder Arthroplasty: a Review

Contreras

Frantz

Bishop

et al. 2020

Curr Rev Musculoskelet Med

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“…Therefore, different methods for the prevention of infection were used, and we could not determine which method was most effective at reducing infection rates. However, a recent study by Butchalter et al 16 assessed the effectiveness of povidone-iodine lavage with VP at reducing infection rates following primary TKA. The authors concluded that this combination may be a cost-effective method for reducing infection rates early following TKA.…”

Section: Resultsmentioning

confidence: 99%

The efficacy of vancomycin powder in total knee arthroplasty

Aljuhani

Alanazi

Alghafees

et al. 2021

SMJ

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Objectives: To assess the efficacy of vancomycin powder (VP) in total knee arthroplasty (TKA). Methods: The study design was retrospective cohort. All patients who underwent primary TKA for osteoarthritis between January 1, 2018, and March 1, 2020, in King Abdulaziz Medical City, Riyadh, Saudi Arabia were included (n=98). Of the total participants, 48 participants in the experimental group matched with 48 participants in the control group were included in the final study sample. Numerical variables are reported as means, standard deviations, and standard errors. The hypothesis was tested using the Chi-square test and independent t-test. Results: In comparison to the control group, intraoperative vancomycin powder (VP) did not decrease surgical site infection risk in the experimental group ( p =0.31). Conclusion: We found no significant differences in the infection rates following primary TKA when using VP.

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“…Furthermore, calcium sulfate use has been associated with aseptic seroma and wound drainage issues [13 , 41] . With regards to vancomycin-induced nephrotoxicity, previous orthopedic literature has not shown significant risk for renal injury with vancomycin powder [42][43][44] or vancomycinimpregnated calcium sulfate [16] . While these were not reported in the present study, further examination and vigilance is needed for these issues in the continued use of calcium sulfate adjuncts.…”

Section: Discussionmentioning

confidence: 96%

Vancomycin-impregnated calcium sulfate beads compared with vancomycin powder in adult spinal deformity patients undergoing thoracolumbar fusion

Xiong

Fogel

Tobert

et al. 2021

North American Spine Society Journal (NASSJ)

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Introduction Adult spinal deformity (ASD) surgery patients are at higher risk for surgical site infections (SSIs) due to large incisions, high blood loss, long surgical duration, and extensive instrumentation. The use of vancomycin powder has demonstrated inconsistent results in ASD surgery. Antibiotic-impregnated calcium sulfate beads have been used in arthroplasty and foot and ankle surgery with promising results. The purpose of this study was to provide preliminary data on the use of vancomycin-impregnated calcium sulfate beads in the prevention of SSI following ASD surgery and provide comparisons to the use of vancomycin powder. Methods A retrospective chart review was performed for 95 consecutive surgical ASD patients at a tertiary care center from January 2017 until March 2020. Patients received either vancomycin powder (powder group) or vancomycin-impregnated calcium sulfate beads (bead group) intrawound prior to closure. Patient demographics, operative course, and incidence of postoperative infections were recorded. A two-tailed chi-squared test was performed to compare infection rates. Results Ninety-five patients were included for review. Forty-two patients were in the powder group and 53 patients were in the bead group. The bead group was older (59.8 vs 67.8 years, p < 0.01) with similar BMI and rates of diabetes, smoking, and length of surgery. There were four postoperative SSI in the powder group requiring operative irrigation and debridement and one SSI in the bead group (9.5% vs 1.9%, p = 0.09). All infections occurred in the first 90 days of the postoperative period. Conclusion Preliminary examination of the use of vancomycin-impregnated calcium sulfate beads demonstrated a 1.9% surgical site infection rate in adult spinal deformity surgical patients, which was not significantly different compared with the 9.5% infection rate in patients who received vancomycin powder. Prospective study is needed to determine if the differences found are significant in a larger number of patients.

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Vancomycin Powder and Dilute Povidone-Iodine Lavage for Infection Prophylaxis in High-Risk Total Joint Arthroplasty

Cited by 50 publications

References 20 publications

Periprosthetic Infection After Reverse Shoulder Arthroplasty: a Review

Periprosthetic Infection After Reverse Shoulder Arthroplasty: a Review

The efficacy of vancomycin powder in total knee arthroplasty

Vancomycin-impregnated calcium sulfate beads compared with vancomycin powder in adult spinal deformity patients undergoing thoracolumbar fusion

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