Intraosseous injection may sustain vancomycin levels in tissues during THA
Click Here to Manage Email Alerts
Key takeaways:
- Intraosseous vancomycin levels were minimally detected at the end of the procedure vs. IV vancomycin levels.
- Intraosseous and IV vancomycin yielded no 90-day complications.
LAS VEGAS — Results of the Otto Aufranc Award-winning paper showed higher concentrations of vancomycin and significantly lower systemic vancomycin levels with intraosseous vancomycin injection among patients who had total hip arthroplasty.
“This technique could be expanded to many different procedures, including joint arthroplasties throughout the body and fracture care,” Katharine D. Harper, MD, said about results presented at the Hip Society Specialty Day as part of the American Academy of Orthopaedic Surgeons Annual Meeting.
Harper and colleagues randomly assigned 20 patients undergoing THA to receive either IV vancomycin or an intraosseous vancomycin injection, which was an intraosseous infusion to the greater trochanter at the time of surgical incision.
“All patients also received IV cephalosporin within 1 hour of incision,” Harper said.
Researchers collected serum vancomycin levels and soft tissue samples from the gluteus maximus at the beginning and end of the procedure, as well as tissue samples within the acetabulum immediately after hip dislocation. Researchers also collected femoral head, acetabular reaming and intramedullary bone samples.
“Once samples were collected, they were minced and then weighted,” Harper said. “Vancomycin tissue concentrations were measured using high-performance liquid chromatography. Vancomycin blood analyses were performed by standard-level lab testing, and then they were compared using standard t-tests.”
Harper noted intraosseous levels were undetectable systemically at the beginning of the procedure and only minimally detectable at the end of the procedure. However, she added IV vancomycin levels were significantly detected. Tissue samples from the intraosseous infusion group had higher vancomycin concentrations vs. tissue samples in the IV fusion group, which was statistically significant in the acetabulum and approached significance in the medical calcar, according to Harper.
“There were no 90-day complications reported in either group,” Harper said.
Collapse
Harper KD, et al. Intraosseous vancomycin in total hip arthroplasty – superior tissue concentrations and improved efficacy. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting. March 7-11, 2023; Las Vegas.
Read more about
Click Here to Manage Email Alerts