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©The Author(s) 2023.
World J Orthop. Aug 18, 2023; 14(8): 589-597
Published online Aug 18, 2023. doi: 10.5312/wjo.v14.i8.589
Published online Aug 18, 2023. doi: 10.5312/wjo.v14.i8.589
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) | - |
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 |
- Citation: Mancino F, Yates PJ, Clark B, Jones CW. Use of topical vancomycin powder in total joint arthroplasty: Why the current literature is inconsistent? World J Orthop 2023; 14(8): 589-597
- URL: https://www.wjgnet.com/2218-5836/full/v14/i8/589.htm
- DOI: https://dx.doi.org/10.5312/wjo.v14.i8.589