Intraosseous vancomycin may reduce PJI risk in revision TKA
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Key takeaways:
- Results showed use of IV vancomycin was linked with a higher periprosthetic joint infection risk vs. use of intraosseous vancomycin.
- There were no incidences of vancomycin-associated toxicity in either group.
DALLAS — Data presented at the American Association of Hip and Knee Surgeons Annual Meeting showed use of intraosseous vancomycin infusion may reduce periprosthetic joint infection vs. IV vancomycin in revision total knee arthroplasty.
Colin A. McNamara, MD, MBA, assistant professor of orthopedic surgery at the University of Miami Miller School of Medicine, and colleagues retrospectively reviewed data from 843 aseptic revision TKAs and compared the surgical outcomes of patients who either received 500 mg of intraosseous (IO) vancomycin infused directly into their tibia or a weight-based dose of IV vancomycin. Patients in both groups also received a weight-based dose of cefazolin. The primary outcome measured was the rate of PJI between groups.
At 30 days postoperatively, McNamara and colleagues found patients who received IV vancomycin had a 2.1% rate of PJI vs. 0.3% in the IO vancomycin group. At 90 days postoperatively, patients who received IV vancomycin had a 3.1% rate of PJI vs. 0.9% in the IO vancomycin group. And at 1-year postoperatively, patients who received IV vancomycin had a 4.9% rate of PJI vs. 1.6% in the IO vancomycin group.
In addition, McNamara said there were no incidences of vancomycin-associated toxicity in either group and no differences in complications across groups.
“We conclude that IO infusion is a safe and effective alternative to the standard IV route of vancomycin administration in the aseptic revision total knee setting,” McNamara said. “But certainly, randomized studies are indeed warranted.”
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McNamara CA, et al. Paper 21. Presented at: American Association of Hip and Knee Surgeons Annual Meeting; Nov. 7-10, 2024; Dallas.
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