Use of topical vancomycin powder in total joint arthroplasty: Why the current literature is inconsistent?

Table 1 Serum and local levels of vancomycin at different post-wound closure collection times

Procedure	Serum levels after wound closure of VP intrawound administration (g/mL)
	1.5 h (mean ± SD; max)	3 h (mean ± SD; max)	12 h (mean ± SD; max)	24 h (mean ± SD; max)	Highest level observed across the 24-h period
THA (n = 15)	3.8 ± 3.9; 9.5	4.9 ± 4.5; 12.7	5.1 ± 3.3; 8.4	3.5 ± 3.5; 8.0	6.6 ± 3.8; 12.7
TKA (n = 19)	1.0 ± 2.5; 8.7	1.8 ± 3.2; 9.8	4.4 ± 3.1; 7.3	3.5 ± 3.6; 10.4	5.2 ± 3.4; 10.4
THA + TKA (n = 34)	2.2 ± 3.4; 9.5	3.2 ± 4.1; 12.7	4.7 ± 3.2; 8.4	3.5 ± 3.5; 10.4	5.8 ± 3.6; 12.7
	Local levels after wound closure of VP intrawound administration, n (g/mL)
	-	3 h (mean ± SD)	12 h (mean ± SD)	24 h (mean ± SD)	-
THA	-	988 ± 628 (12)	769 ± 1059 (11)	280 ± 436 (11)	-
TKA	-	877 ± 455 (18)	288 ± 203 (16)	163 ± 220 (18)	-
THA + TKA	-	922 ± 523 (30)	484 ± 716 (27)	207 ± 317 (29)	-

VP: Vancomycin powder; THA: Total hip arthroplasty; TKA: Total knee arthroplasty. Adapted from: Johnson JD, Nessler JM, Horazdovsky RD, Vang S, Thomas AJ, Marston SB. Serum and Wound Vancomycin Levels After Intrawound Administration in Primary Total Joint Arthroplasty. J Arthroplasty 2017 Mar; 32(3): 924-928. Copyright © 2015 Elsevier Inc. All rights reserved.