Prophylactic vancomycin mixed bone cement in primary joint replacement surgery

Abstract

Background: Infection is most serious complication in joint replacement surgeries. Apart from maintaining sterility in operation theatre and preoperative intravenous antibiotic prophylaxis, local antibiotic delivering systems are proven to be effective1. Currently Polymethylmethacrylate (PMMA) is widely used as bone cement for delivering antibiotics and accepted as the current standard antibiotic delivery vehicle in orthopaedic surgery. Considering cost effectiveness of the commercially available antibiotic loaded bone cement (ALBC) and feasibility in rural India, we decided to mix vancomycin with bone cement manually and studied its effectiveness in joint replacement surgeries.Methods: This was a prospective randomized case series study. Total 98 patients having 40 cemented bipolar, 20 cemented THR, 38 TKR involved in the study. Posterior approach was taken for taken for THR and bipolar hemiarthroplasty, medial parapatellar approach was taken for TKR. 40 grams of bone cement is mixed manually mixed with 1 gram of vancomycin powder. Cement was used as standard technique in these surgeries. Weight bearing done as for the tolerance and were followed up at 1,3 and 6 months assessed with CBC, ESR, CRP and X rays.Results: Out of 98 patients 5 patients lost follow up in which there were 3 Bipolar hemiarthroplasty and 2 THR. Out of 93 patients two bipolar, one THR and one TKR patient died because of causes not related to our study. In total remaining 89 patients, there was superficial infection in one TKR patient which was treated with superficial debridement resuturing.Conclusions: We found that by this technique infection rate is significantly reduced, however we have small sample size and we don’t have control group.