Topical application of vancomycin in prevention of early incision infection in total knee arthroplasty
Li Zhengyuan, Hao Lin, Chen Shenghong, Peng Kai, Wang Jun, Yin Zongsheng
Department of Joint Surgery, First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
Abstract: BACKGROUND: The use of vancomycin in total knee arthroplasty is a controversial strategy for the prevention of incisional infection. At present, there is little evidence to evaluate the efficacy of this preventive measure in China.
OBJECTIVE: To evaluate the efficacy of local vancomycin in the prevention of early postoperative incision infection during total knee arthroplasty.
METHODS: 120 patients with osteoarthritis of the knee who received unilateral total knee arthroplasty for the first time at Department of Joint Surgery of First Affiliated Hospital of Anhui Medical University from March to June 2022 were included in this study. They were randomly divided into the observation group and the control group, with 60 cases in each group. All patients gave informed consent to the treatment plan. In the observation group, 1 g of vancomycin was applied intraoperatively; in the control group, no vancomycin was applied intraoperatively. Erythrocyte sedimentation rate, C-reactive protein, fever rate on seven consecutive days after surgery, degree of knee joint swelling, cumulative drainage volume, and incidence of periprosthetic joint infection were recorded in two groups of patients on days 1, 3, and 5 after surgery so as to evaluate the efficacy of topical vancomycin in total knee arthroplasty for the prevention of incision infection in the early postoperative period.
RESULTS AND CONCLUSION: (1) The differences in erythrocyte sedimentation rate and C-reactive protein between the two groups on days 1, 3, and 5 after surgery were not significant (P > 0.05). (2) The difference in fever rate between the two groups for 7 consecutive days after surgery was not significant (P > 0.05). (3) There was no significant difference in the degree of postoperative knee swelling and cumulative drainage flow between the two groups (P > 0.05). (4) The difference in the incidence of periprosthetic joint infection one year after surgery was not significant between the two groups (P > 0.05). (5) The results suggest that the local use of vancomycin in total knee arthroplasty has not shown significant efficacy in preventing incision infection in the early postoperative period.
Key words: total knee arthroplasty, vancomycin, incision infection, fever, periprosthetic joint infection, erythrocyte sedimentation rate, C-reactive protein, drainage