Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 7, 2022; 10(1): 71-78
Published online Jan 7, 2022. doi: 10.12998/wjcc.v10.i1.71
Vancomycin lavage for the incidence of acute surgical site infection following primary total hip arthroplasty and total knee arthroplasty
Ming-Yi Duan, Hang-Zhou Zhang
Ming-Yi Duan, Hang-Zhou Zhang, Department of Orthopedics, Joint Surgery and Sports Medicine, First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
Author contributions: Duan MY, Zhang HZ contributed equally to this work; and all authors have read and approve the final manuscript.
Institutional review board statement: The study was reviewed and approved by the First Affiliated Hospital of China Medical University Institutional Review Board (Approval No.AF-SOP-07-1.1-01).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: No conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hang-Zhou Zhang, MD, Doctor, Department of Orthopedics, Joint Surgery and Sports Medicine, First Affiliated Hospital of China Medical University, No. 155 Nanjing North Street, Shenyang 110001, Liaoning Province, China. zhanghz1000@sina.com
Received: August 10, 2021
Peer-review started: August 10, 2021
First decision: September 2, 2021
Revised: October 21, 2021
Accepted: November 23, 2021
Article in press: November 23, 2021
Published online: January 7, 2022
Processing time: 141 Days and 23.2 Hours
Abstract
BACKGROUND

Surgical site infection is a rare but serious complication associated with total joint arthroplasty (TJA). There are limited data on the effectiveness of intrawound irrigation with vancomycin solution (1000 mg/L; 2 L) before wound closure for preventing acute surgical site infection following primary total hip arthroplasty (THA) and total knee arthroplasty (TKA).

AIM

To investigate the effectiveness of prophylactic intraoperative application of vancomycin (1000 mg/L; 2 L) solution vs. plain irrigation in reducing the incidence of acute surgical site infection following primary THA and TKA.

METHODS

A retrospective review of 2725 consecutive patients undergoing THA or TKA from January 2012–December 2019 was performed. These patients received either intrawound irrigation with normal saline before wound closure between January 2012 and December 2015 (group 1, 1018 patients; 453 undergoing THA and 565 undergoing TKA) or intrawound irrigation with vancomycin solution (1000 mg/L) before wound closure between January 2016 and December 2019 (group 2, 1175 patients; 512 undergoing THA and 663 undergoing TKA). The outcomes were the incidences of postoperative surgical site infection and wound healing complications within 3 mo of primary TJA.

RESULTS

There were no significant demographic differences between the 2 groups. There was a significantly higher incidence of acute infection at the surgical site in patients who received intrawound irrigation with normal saline before wound closure than in those who received intrawound irrigation with vancomycin solution (1000 mg/L; 2 L) before wound closure (overall incidence of infection: group 1, 2.46% vs group 2, 0.09%, P < 0.001). There was no significant difference in the incidence of wound healing complications between the two groups.

CONCLUSION

Prophylactic irrigation with vancomycin solution (1000 mg/L; 2 L) significantly decreases the incidence of acute surgical site infection after primary TJA. This strategy is a safe, efficacious, and inexpensive method for reducing the incidence of acute surgical site infection after TJA.

Keywords: Total joint arthroplasty, Total hip arthroplasty, Total knee arthroplasty, Vancomycin irrigation, Postoperative acute wound infection, Acute surgical site infection

Core Tip: Prophylactic irrigation with vancomycin solution (1000 mg/L; 2 L) significantly decreases the incidence of acute surgical site infection after primary total joint arthroplasty (TJA). This represents a safe, efficacious, and inexpensive method for reducing the incidence of acute surgical site infection after TJA.