Mohammad Naghi Tahmasebi1, Arash Sharafat Vaziri2, Fardis Vosoughi2, Mohamad Tahami3,4, Majid Khalilizad5,6, Hamid Rabie7. 1. Knee, Sport and Reconstruction Surgery, Knee Surgery Fellowship Program, Orthopaedic Surgery Department, Shariati Hospital and School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. 2. Fellowship of Knee, Sport and Reconstruction Surgery, Department of Orthopaedic and Trauma Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. 3. Department of Orthopaedic and Trauma Surgery, Shariati Hospital and School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. 4. Fellowship of Knee, Sport and Reconstruction Surgery, Department of Orthopaedic Surgery, Chamran Hospital, Shiraz University of Medical Sciences, Shiraz, Iran. 5. Fellowship of Knee, Sport and Reconstruction Surgery, Department of Orthopaedic and Trauma Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. majidkhalilizad@yahoo.com. 6. Bone and Joint Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. majidkhalilizad@yahoo.com. 7. Department of Orthopaedic Surgery, Shahid Beheshti Hospital, Babol University of Medical Sciences, Babol, Mazandaran, Iran.
Abstract
BACKGROUND: Utilizing intrawound vancomycin powder in TKA surgery has yielded rather contrasting results in the current literature. Furthermore, CDC criteria, although effective in general, are not specifically designed for post-TKA infections. Here, we present a 7-year experience of vancomycin use in primary TKA in a high-volume tertiary knee center in Iran. Also, new criteria are proposed to detect suspected superficial post-TKA infections. METHODS: This is a retrospective analysis of primary total knee arthroplasties performed in a tertiary knee center, from March 2007 to December 2018, by a single senior knee surgeon. All patients with follow-up periods of less than 1 year were excluded from the study. Since March 2011, all patients received vancomycin (powder, 1 g) before water-tight closure of the joint capsule. A comparison was made between this group and historical control subjects (operated from March 2007 to March 2011). RESULTS: Altogether, 2024 patients were included in the study. The vancomycin and the control groups included 1710 and 314 cases respectively. Patients were mostly women (male to female ratio, 1 to 4), with a mean age of 65.20 (SD = 10.83) years. In the vancomycin group, the rate of suspected SII (1.87%) and PJI (0.41%) was significantly lower than the control group (P = 0.002). CONCLUSIONS: Our experience shows that application of local vancomycin during TKA surgery could be a reasonable infection prevention measure, although prospective randomized studies are required to evaluate its efficacy.
BACKGROUND: Utilizing intrawound vancomycin powder in TKA surgery has yielded rather contrasting results in the current literature. Furthermore, CDC criteria, although effective in general, are not specifically designed for post-TKA infections. Here, we present a 7-year experience of vancomycin use in primary TKA in a high-volume tertiary knee center in Iran. Also, new criteria are proposed to detect suspected superficial post-TKA infections. METHODS: This is a retrospective analysis of primary total knee arthroplasties performed in a tertiary knee center, from March 2007 to December 2018, by a single senior knee surgeon. All patients with follow-up periods of less than 1 year were excluded from the study. Since March 2011, all patients received vancomycin (powder, 1 g) before water-tight closure of the joint capsule. A comparison was made between this group and historical control subjects (operated from March 2007 to March 2011). RESULTS: Altogether, 2024 patients were included in the study. The vancomycin and the control groups included 1710 and 314 cases respectively. Patients were mostly women (male to female ratio, 1 to 4), with a mean age of 65.20 (SD = 10.83) years. In the vancomycin group, the rate of suspected SII (1.87%) and PJI (0.41%) was significantly lower than the control group (P = 0.002). CONCLUSIONS: Our experience shows that application of local vancomycin during TKA surgery could be a reasonable infection prevention measure, although prospective randomized studies are required to evaluate its efficacy.
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