Abstract
BackgroundUtilizing intrawound vancomycin powder in TKA surgery has yielded rather contrasting results in the current literature. Furthermore, CDC criteria, although effective in general, are not specifically designed for post-TKA infections. Here, we present a 7-year experience of vancomycin use in primary TKA in a high-volume tertiary knee center in Iran. Also, new criteria are proposed to detect suspected superficial post-TKA infections.MethodsThis is a retrospective analysis of primary total knee arthroplasties performed in a tertiary knee center, from March 2007 to December 2018, by a single senior knee surgeon. All patients with follow-up periods of less than 1 year were excluded from the study. Since March 2011, all patients received vancomycin (powder, 1 g) before water-tight closure of the joint capsule. A comparison was made between this group and historical control subjects (operated from March 2007 to March 2011).ResultsAltogether, 2024 patients were included in the study. The vancomycin and the control groups included 1710 and 314 cases respectively. Patients were mostly women (male to female ratio, 1 to 4), with a mean age of 65.20 (SD = 10.83) years. In the vancomycin group, the rate of suspected SII (1.87%) and PJI (0.41%) was significantly lower than the control group (P = 0.002).ConclusionsOur experience shows that application of local vancomycin during TKA surgery could be a reasonable infection prevention measure, although prospective randomized studies are required to evaluate its efficacy.
Highlights
Utilizing intrawound vancomycin powder in Total knee arthroplasty (TKA) surgery has yielded rather contrasting results in the current literature
Some studies [22] have used the US Centers for Disease Control and Prevention (CDC) criteria for identifying surgical site infections which were defined by the CDC in 1992 as those occurring within 30 days of surgery [23]
We present a 7-year experience of vancomycin use in a high-volume tertiary knee center in Iran and we set out to report our findings as well as discuss the reasonable explanations
Summary
Utilizing intrawound vancomycin powder in TKA surgery has yielded rather contrasting results in the current literature. CDC criteria, effective in general, are not designed for post-TKA infections. Intraoperative use of vancomycin powder has been shown to be effective in reducing the chance of infection in spine surgeries [14,15,16], but literature on its use in TKA surgery has yielded rather contrasting results [17,18,19]. The latest consensus on PJI has provided some valuable criteria to diagnose a deep infection [20], but literature on the detection of superficial infection after TKA is not clear [21, 22]. It does not seem logical to wait for wound drainage and positive cultures to intervene
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