Serum and synovial vancomycin concentrations following prophylactic administration in knee arthroplasty.

A single preoperative dose of 15 mg/kg of total body weight, to a maximum of 1 g of vancomycin, was administered intravenously to patients undergoing knee arthroplasty prior to anesthesia. Vancomycin concentration levels were examined in 39 patients. Vancomycin levels were analyzed preoperatively, intraoperatively, and postoperatively. Results confirmed effective serum and synovial vancomycin levels during surgery. Effective therapeutic levels of vancomycin remained in the knee >20 hours postoperatively. Although vancomycin is not commonly used as a prophylactic antibiotic in arthroplasty, it should be considered in patients with known hypersensitivity to penicillin, or when methicillin-resistant Staphylococcus aureus in present.