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Paper of the week: No effect of vancomycin powder to prevent infection in primary total knee arthroplasty: a retrospective review of 976 cases

Paper of the week: No effect of vancomycin powder to prevent infection in primary total knee arthroplasty: a retrospective review of 976 cases. Yavuz IA, Oken OF, Yildirim AO, Inci F, Ceyhan E, Gurhan U. Knee Surg Sports Traumatol Arthrosc. 2019 Nov 14. doi: 10.1007/s00167-019-05778-8.

Summary and editorial by Dr Marjan Wouthuyzen-Bakker

In this paper of the week, Yavuz et al. studied the efficacy of vancomycin powder (VP) in preventing PJI after primary total knee arthroplasty. The authors compared 474 patients treated with local VP with a retrospective cohort of 502 control patients, without any other changes made in prevention measurements during the studied period. The minimal follow-up in both groups was 2 years. VP did not reduce the overall PJI rate (PJI rate 0.84% in the VP group vs 0.99% in the control group, P 0.54). In addition, no difference was observed for early or late infections.

Until now, the potential of VP in reducing post-operative infections is primarily demonstrated in spine surgery. Some studies report a reduction of infections in arthroplasties [1-2], but because other prevention measurements apart from the VP were applied in these studies also, the effect of VP per se cannot be made. The current study showed no effect of VP in primary knee arthroplasties. However, a potential limitation of the study was the use of a hemovac drain for 24h after surgery. Although the drains were clamped for the first 4 postoperative hours, its application could have reduced the efficacy of local antibiotics, as acknowledged by the authors themselves also.

References

  1. Whiteside LA. Prophylactic peri-operative local antibiotic irrigation. Bone Joint J 2016; 98-B:23-26.
  2. Winkler C, Dennison J, Wooldridge A et al. Do local antibiotics reduce periprosthetic joint infections? A retrospective review of 744 cases. J Clin Orthop Trauma 2018; 9:34-39.