Intrawound vancomycin powder in primary total knee arthroplasty: Does it reduce early postoperative infection?

IF 1.6 4区医学 Q3 ORTHOPEDICS Knee Pub Date : 2024-10-30 DOI:10.1016/j.knee.2024.10.008

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Abstract

Background

The purpose of this retrospective analysis of a prospective quality control project was to determine whether the use of intrawound vancomycin powder (IVP) decreases the rate prosthetic joint infection (PJI) within 90-days following primary total knee arthroplasty (TKA).

Methods

From October 2021-September 2022, a prospective quality control project was undertaken in which 10 high-volume arthroplasty surgeons alternated between using IVP and not using IVP each month. Patients who received IVP were compared to those who did not. The primary outcome was culture positive PJI within 90-days following primary total knee arthroplasty. Secondary outcomes included overall reoperation rate, wound complications, and readmission within 90-days post-operatively.

Results

A total of 1,317 primary TKA patients were identified for analysis. Fifty-six and seven tenths percent (n = 747) of patients were included in the IVP group and 43.3% (n = 570) patients were included in the non-IVP group. The overall PJI rate was 0.5%. There was no difference in 90-day culture positive PJI rates between the groups (0.7% vs. 0.2%, p = 0.24). The overall reoperation rate did not differ between the IVP and non-IVP group (6.4% vs. 4.6%, p = 0.15). Reoperation for suspected infection was not statistically different by IVP administration (1.2% vs. 0.5%, p = 0.25). Additionally, there were no differences in the incidence of wound complications (p = 0.80) or readmissions (p = 0.15).

Conclusions

The overall infection rate for this cohort was low. IVP was not associated with decreased culture positive PJI, wound complications, reoperation or readmission rates. Further analysis of IVP use in TKA should be undertaken to fully determine its efficacy and safety profile.

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原发性全膝关节置换术中的伤口内万古霉素粉：它能减少术后早期感染吗？

背景：这项前瞻性质量控制项目的回顾性分析旨在确定使用万古霉素粉（IVP）是否会降低初次全膝关节置换术（TKA）后 90 天内的假体关节感染（PJI）率：方法：2021年10月至2022年9月期间，开展了一项前瞻性质量控制项目，10名工作量大的关节置换外科医生每月交替使用或不使用IVP。接受 IVP 治疗的患者与未接受 IVP 治疗的患者进行比较。主要结果是初级全膝关节置换术后 90 天内 PJI 培养阳性。次要结果包括总体再手术率、伤口并发症和术后90天内的再入院率：共有 1,317 名初级全膝关节置换术患者接受了分析。56.7%的患者（n = 747）被纳入IVP组，43.3%的患者（n = 570）被纳入非IVP组。总的 PJI 发生率为 0.5%。两组患者的 90 天培养阳性 PJI 率没有差异（0.7% 对 0.2%，P = 0.24）。IVP 组和非 IVP 组的总再手术率没有差异（6.4% 对 4.6%，P = 0.15）。因疑似感染而再次手术的比例在统计学上没有因使用 IVP 而不同（1.2% 对 0.5%，P = 0.25）。此外，伤口并发症（p = 0.80）或再住院（p = 0.15）的发生率也没有差异：结论：该队列的总体感染率较低。IVP与培养阳性PJI、伤口并发症、再次手术或再次入院率的降低无关。应进一步分析 IVP 在 TKA 中的应用，以全面确定其疗效和安全性。

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来源期刊

Knee 医学-外科

CiteScore

3.80

自引率

5.30%

发文量

171

审稿时长

6 months

期刊介绍： The Knee is an international journal publishing studies on the clinical treatment and fundamental biomechanical characteristics of this joint. The aim of the journal is to provide a vehicle relevant to surgeons, biomedical engineers, imaging specialists, materials scientists, rehabilitation personnel and all those with an interest in the knee. The topics covered include, but are not limited to: • Anatomy, physiology, morphology and biochemistry; • Biomechanical studies; • Advances in the development of prosthetic, orthotic and augmentation devices; • Imaging and diagnostic techniques; • Pathology; • Trauma; • Surgery; • Rehabilitation.