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

Table 2 Main characteristics and results of the recent literature on the topic vancomycin powder

Ref.	Type of study	No. of studies	No. of cases (control/intervention)	PJI Rate/RR (control vs intervention)	SSI/Aseptic wound complications (control vs intervention)	Authors’ conclusions
Martin et al[36], 2022	Systematic review and meta-analysis	7/7	144724/8029	RR 0.39 (95%CI 0.27-0.56, P < 0.001)	6.48% vs 3.79%	VP ± PI lavage reduced PJI rate in primary and revision THA/TKA. Associated with reduced aseptic wound complications
Liao et al[35], 2022	Systematic review and meta-analysis	14	7720/1292	RR 0.41 (95%CI 0.29-0.58, P < 0.001)	-	VP recommended in primary TKA
Movassaghi et al[30], 2022	Systematic review and meta-analysis	16	3731/17164	1.65% vs 0.87% (P < 0.05)	-	Local VP may reduce the risk of PJI in primary and revision TJA
Wong et al[31], 2021	Systematic review	9	6255/3371	-	No difference	Recommend the surgeons not to use VP in routine THA and TKA
Peng et al[32], 2021	Systematic review and meta-analysis	9	4512/2354	RR 0.37 (95%CI 0.23- 0.60, P < 0.001)	RR = 0.40, 95%CI 0.27-0.61 (P < 0.001)	Local VP could significantly decrease the rate of SSI and PJI in primary TJA
Saidahmed et al[33], 2021	Systematic review and meta-analysis	9	3714/1985	3.5% vs 1.6%, RR 0.53 (95%CI 0.35-0.79, P = 0.002, I2 = 0.0%)	No difference 1.6% vs 0.7%, RR = 0.61, 95%CI 0.17-2.12, (P = 0.43, I2 = 0.0%)	Local antibiotic application results in a moderate reduction in deep infection rates in primary TJA, with no significant impact on SSI rate
Xu et al[34], 2020	Systematic review and meta-analysis	9	4607/2497	2.75% vs 1.20% (OR 0.44, 95%CI 0.28-0.69, I2 = 0.0%)	No difference 1.60% vs 0.67% (OR 0.60, 95%CI 0.17-2.12, I2 = 0.0%)	VP used in primary hip and knee arthroplasty may reduce the incidence of PJI but it may increase the risk of aseptic wound complications

RR: Relative risk; SSI: Superficial site infection; VP: Vancomycin powder; PI: Povidone iodine; PJI: Periprosthetic joint infection; THA: Total hip arthroplasty; TKA: Total knee arthroplasty; TJA: Total joint arthroplasty; OR: Odds ratio.