Intraosseous vancomycin given during THA showed higher concentrations vs. IV vancomycin
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LAS VEGAS — Intraosseous vancomycin infusion during total hip arthroplasty was feasible for timely delivery of periprosthetic infection prophylaxis, according to a presenter at the American Academy of Orthopaedic Surgeons Annual Meeting.
Katharine D. Harper, MD, presented results of a randomized, prospective blinded study she and her colleagues conducted to determine whether intraosseous (IO) administration of vancomycin in THA was safe and effective.
Harper and colleagues received the Hip Society Otto Aufranc Award for their work during the Hip Society Specialty Day Meeting held during the AAOS Annual Meeting.
“This is a first-of-its-kind study demonstrating the efficacy and utility of using IO vancomycin in primary THAs by showing that the IO vancomycin levels are sustained in the tissues even without the presence of a tourniquet. This technique could be expanded to many different procedures, including joint arthroplasties throughout the body, and fracture care,” Harper said.
Investigators predicted the IO injections or infusions during primary THA would yield equal or superior bone and soft tissue concentrations of vancomycin vs. IV vancomycin administration. They randomized 20 patients into one of two groups to be administered either IO or IV vancomycin during primary THA.
For patients in the IO group, IO infusions were made into the greater trochanter at the time of the surgical incision, according to Harper, who said all patients received IV cephalosporin with 1 hour of incision.
Patients and lab technicians who analyzed the tissue and serum samples were blinded to treatment.
For the IO vancomycin group, surgeons introduced the IO vancomycin after they made a small incision so that it would introduce the vancomycin to the greater trochanter area.
After the IO administration, “your procedure can then proceed as it normally would for the case. So, it’s quick; about 45 seconds,” Harper said.
Vancomycin levels associated with each technique were measured from samples taken from various sources in the patients and different times. Serum vancomycin levels were determined from soft tissue samples taken at the beginning and the end of the case, and tissue concentration levels were determined from bone in three different locations, according to Harper.
“Vancomycin tissue concentrations were measured using high-performance liquid chromatography. Vancomycin blood analyses were performed with standard-level lab testing and then they were compared using standard t-tests,” she said.
The systemic vancomycin concentrations were similar to those Harper and colleagues saw in a study from 2020 that evaluated IO vancomycin infusion used in total knee arthroplasty, “where the IO level was undetectable systemically at the beginning of the case and were only minimally detectable at the end of the case, whereas IV vancomycin levels were significantly detected at both. Both of those findings were statistically significant,” Harper said.
In tissue sample results, “every sample across the board did have higher concentrations using the IO infusion than they did having the IV infusion,” she said. “So higher concentrations we found throughout all bone samples and tissue samples when using IO compared to IV vancomycin.”
Researchers reported patients experienced a few complications, however patients in both groups did not experience 90-day complications.
Reference:
Harper KD, et al. Arthroplast Today. 2020;doi:10.1016/j.artd.2020.02.001.
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Harper KD, et al. The Otto Aufranc Award. Intraosseous vancomycin in total hip arthroplasty – superior tissue concentrations and improved efficiency. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 7-11, 2023; Las Vegas.
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