Articles Vol. 65 No. CĐ11- HN Chấn thương Chỉnh hình-TPHCM 02/12/2024

15. EFFIECIENCY OF INTRAOSSEOUS VANCOMYCIN PROPHYLAXIS IN TOTAL KNEE ARTHROPLASTY

Le Dinh Khoa1,2, Ho Van Duy An1,2, Tran Ngoc Chon1,2, Nguyen Van On1,2
1 Tam Anh General Hospital, Ho Chi Minh City
2 Bệnh viện Đa khoa Tâm Anh Thành phố Hồ Chí Minh
Corresponding author: drdinhkhoa@gmail.com
DOI: 10.52163/yhc.v65iCD11.1750
24 Views
9 Downloads
Keywords
Intraosseous (IO) periprosthetic joint infection total knee arthroplasty (TKA) antibiotic prophylaxis vancomycin
Abstract

Introduction: Intraosseous (IO) vancomycin prophylaxis in total knee arthroplasty has been shown to increase local vancomycin concentration, lower systemic adverse effect, help prevent periprosthetic joint (PJI) infection, especially MRSA (methicillin-resistant Staphylococcus aureus).

Materials and Methods: A retrospective review of 1279 patients underwent total knee arthroplasty at Tam Anh HCM hospital (01/2022-05/2024) with at least 90 days follow-up. There were 795 patients in non-IO group and 484 patients in IO group. The IO group received a 500mg vancomycin mixed with 120ml NaCl 0.9%, injected in proximal tibia after tourniquet, before skin incision. Both groups received prophylaxis cephalosporin and same post-operative treatments.

Results: There are 11 PJI (1.38 %) in non-IO group and 1 PJI (0.2%, p=0.037) in IO group. There were no systemic adverse events in IO group, local vancomycin concentrations were high at beginning and before closure of the surgery.

Conclusions: Intraosseous vancomycin prophylaxis provided a safe and effective, simple way to prevent periprosthetic joint infection in total knee arthroplasty.

References
[1]
Gehrke, T., C. Lausmann, and M. Citak, Still fighting prosthetic joint infection after knee replacement. Lancet Infect Dis, 2019. 19(6): p.560. Google Scholar
[2]
Sandiford, N., M. Franceschini, and D. Kendoff, The burden of prosthetic joint infection (PJI). Annals of Joint, 2021. 6. Google Scholar
[3]
van Veghel, M.H.W., et al., Early Periprosthetic Joint Infections in Total Hip and Knee Arthroplasty: Microorganisms, Mortality, and Implant Survival Using a Combined Dataset From the Dutch Arthroplasty Register and the Dutch National Nosocomial Surveillance Network. J Arthroplasty, 2024. Google Scholar
[4]
Crawford, T., K.A. Rodvold, and J.S. Solomkin, Vancomycin for Surgical Prophylaxis? Clinical Infectious Diseases, 2012. 54(10): p. 1474-1479. Google Scholar
[5]
Young, S.W., et al., The Mark Coventry Award: Higher tissue concentrations of vancomycin with low-dose intraosseous regional versus systemic prophylaxis in TKA: a randomized trial. Clin Orthop Relat Res, 2014. 472(1): p. 57-65. Google Scholar
[6]
Premkumar, A., et al., Projected Economic Burden of Periprosthetic Joint Infection of the Hip and Knee in the United States. J Arthroplasty, 2021. 36(5): p. 1484-1489.e3. Google Scholar
[7]
Clarke, M.T., et al., Contamination of primary total hip replacements in standard and ultra-clean operating theaters detected by the polymerase Google Scholar
[8]
chain reaction. Acta Orthop Scand, 2004. 75(5): p. 544-8. Google Scholar
[9]
Alomar, A.Z., et al., INTRAOPERATIVE EVALUATION AND LEVEL OF CONTAMINATION DURING TOTAL KNEE ARTHROPLASTY. Acta Ortop Bras, 2022. 30(spe1): p. e243232. Google Scholar
[10]
Hill, C., et al., Prophylactic cefazolin versus placebo in total hip replacement. Report of a multicentre double-blind randomised trial. Lancet, 1981. 1(8224): p. 795-6. Google Scholar
[11]
Spangehl, M.J., et al., Higher Tissue Concentrations of Vancomycin Achieved With Low-Dose Intraosseous Injection Versus Intravenous Despite Limited Tourniquet Duration in Primary Total Knee Arthroplasty: A Randomized Trial. J Arthroplasty, 2022. 37(5): p. 857-863. Google Scholar
[12]
Haseeb, A., et al., A Systematic Review on Clinical Safety and Efficacy of Vancomycin Loading Dose in Critically Ill Patients. Antibiotics (Basel), 2022. 11(3). Google Scholar
[13]
Polk, R.E., et al., Vancomycin and the red-man syndrome: pharmacodynamics of histamine release. J Infect Dis, 1988. 157(3): p. 502-7. Google Scholar
[14]
Parkinson, B., et al., Intraosseous Regional Prophylactic Antibiotics Decrease the Risk of Prosthetic Joint Infection in Primary TKA: A Multicenter Study. Clin Orthop Relat Res, 2021. 479(11): p. 2504-2512. Google Scholar
[15]
Burke, J.F., The effective period of preventive antibiotic action in experimental incisions and dermal lesions. Surgery, 1961. 50: p. 161-8. Google Scholar