Role of intra-wound powdered vancomycin in primary total knee arthroplasty

Background: No study has evaluated the effect of topical powdered vancomycin in patients undergoing primary total knee arthroplasty (TKA). The goal of this study is to determine if this method reduces postoperative infection rates following primary TKA. Patients and methods: This retrospective study reviewed 855 consecutive patients undergoing TKA. The first 418 patients, who did not receive topical vancomycin, were grouped into the control group and the subsequent 437 patients, who received powdered vancomycin applied to the target joint prior to wound closure, were grouped into the treatment group. Results: The control group was found to have 18 infectious complications (4.3%) compared with 6 (1.4%) in the treatment group, which differed significantly (p<0.05). When comparing the rates of infectious complications independently, there was no significant difference in the rate of superficial infection (3.1% vs. 1.4%; p > 0.05), while the difference in prevalence of periprosthetic joint infection (PJI) was statistically significant (1.2% vs. 0; p <0.05). No serious adverse events (AEs) occurred. Discussion: Topical application of powdered vancomycin may present a reasonable means of decreasing the risk of infectious complications following TKA. There were no serious AEs associated with topical vancomycin. Further research is needed to focus on its long-term efficacy and safety. (C) 2020 Elsevier Masson SAS. All rights reserved.