Efficacy of Intraarticular Vancomycin in Preventing Infection in Patients Undergoing Hip Hemiarthroplasty
Intraarticular Vancomycin in Preventing Infection in Hip Hemiarthroplasty Patients
DOI:
https://doi.org/10.31661/gmj.v13i.3382Keywords:
Hip Hemiarthroplasty,;Vancomycin; Infection; Intra-ArticularAbstract
Background: Hip fractures are among the top ten causes of disability in adults worldwide. Patients with hip fracture are at significant risk of mortality and morbidity and reduced quality of life. This study was conducted with the aim of investigating the effect of intra-articular vancomycin in preventing infection in patients undergoing hip hemiarthroplasty. Materials and Methods: This double-blind controlled clinical trial study was conducted on 48 patients with femoral neck fracture candidates for hip hemiarthroplasty hemiarthroplasty in Orthopedic clinic of Golestan and Imam Khomeini Hospital, Ahvaz, Iran between June and November 2023. Eligible patients were divided into two equal groups. The intervention group received 1gram vancomycin intra-articularly during the operation before closure of fascia, and the control group did not receive vancomycin. The patients were followed up for 6 months after the operation, and the rate of superficial infection, periprosthetic joint infection (PJI) and wound complications were compared in two groups. The obtained data were statistically analyzed with IBM SPSS Statistics 21.0 for Windows. Results: The vancomycin group and the control group had no significant difference in the incidence of overall infection. The PJI in vancomycin and control groups were 4.16% and 8.33%, respectively. This difference was not statistically considerable (P=0.55). The results showed the incidence of superficial estimated 8.33% in vancomycin group and 4.16% in control group with no considerable difference in infection (P=0.52). Moreover, there was no meaningful difference in side effects between the two groups (P=0.63). There was no significant difference in wound complications between the two groups (P=0.3). . Conclusion: Intra-articular injection of 1gram of vancomycin suspension did not reduce the overall, superficial and deep infection after surgery. It is suggested that more clinical trial studies with higher sample size be conducted.
References
Investigators H. Total hip arthroplasty or hemiarthroplasty for hip fracture. New England Journal of Medicine. 2019;381(23):2199-208.
https://doi.org/10.1056/NEJMoa1906190
Matziolis G, Brodt S, Böhle S, Kirschberg J, Jacob B, Röhner E. Intraarticular vancomycin powder is effective in preventing infections following total hip and knee arthroplasty. Scientific Reports. 2020;10(1):13053.
https://doi.org/10.1038/s41598-020-69958-0
Farey JE, Cuthbert AR, Adie S, Harris IA. Bipolar hemiarthroplasty does not result in a higher risk of revision compared with total hip arthroplasty for displaced femoral neck fractures: an instrumental variable analysis of 36,118 procedures from the Australian Orthopaedic Association National Joint Replacement Registry. JBJS. 2022;104(10):919-27.
https://doi.org/10.2106/JBJS.21.00972
Kim S-J, Cho YJ. Current guideline for diagnosis of periprosthetic joint infection: a review article. Hip & pelvis. 2021;33(1):11.
https://doi.org/10.5371/hp.2021.33.1.11
Liao S, Yang Z, Li X, Chen J, Liu J-g. Effects of different doses of vancomycin powder in total knee and hip arthroplasty on the periprosthetic joint infection rate: a systematic review and meta-analysis. Journal of Orthopaedic Surgery and Research. 2022;17(1):546.
https://doi.org/10.1186/s13018-022-03445-2
Guren E, Figved W, Frihagen F, Watne LO, Westberg M. Prosthetic joint infection-a devastating complication of hemiarthroplasty for hip fracture. Acta Orthopaedica. 2017;88(4):383-9.
https://doi.org/10.1080/17453674.2017.1301009
Movassaghi K, Wang JC, Gettleman BS, Mayfield CK, Oakes DA, Lieberman JR, et al. Systematic review and meta-analysis of intrawound vancomycin in total hip and total knee arthroplasty: A continued call for a prospective randomized trial. The Journal of Arthroplasty. 2022;37(7):1405-15. e1.
https://doi.org/10.1016/j.arth.2022.03.047
Parvizi J, Gehrke T, Chen A. Proceedings of the international consensus on periprosthetic joint infection. The bone & joint journal. 2013;95(11):1450-2.
https://doi.org/10.1302/0301-620X.95B11.33135
Lora-Tamayo J, Euba G, Ribera A, Murillo O, Pedrero S, García-Somoza D, et al. Infected hip hemiarthroplasties and total hip arthroplasties: Differential findings and prognosis. Journal of Infection. 2013;67(6):536-44.
https://doi.org/10.1016/j.jinf.2013.07.030
Mamarelis G, Key S, Snook J, Aldam C. Outcomes after early return to theatre following hip hemiarthroplasty for intracapsular fracture of the femoral neck. The Bone & Joint Journal. 2017;99(7):958-63.
https://doi.org/10.1302/0301-620X.99B7.BJJ-2016-0890.R1
Erken HY, Nusran G, Karagüven D, Yilmaz O, Kuru T. No decrease in infection rate with the use of local vancomycin powder after partial hip replacement in elderly patients with comorbidities. Cureus. 2020;12(9).
https://doi.org/10.7759/cureus.10296
Dhammi IK, Haq RU, Kumar S. Prophylactic antibiotics in orthopedic surgery: Controversial issues in its use. Indian journal of orthopaedics. 2015;49(4):373.
https://doi.org/10.4103/0019-5413.159556
Murphy E, Spencer S, Young D, Jones B, Blyth M. MRSA colonisation and subsequent risk of infection despite effective eradication in orthopaedic elective surgery. The Journal of Bone & Joint Surgery British Volume. 2011;93(4):548-51.
https://doi.org/10.1302/0301-620X.93B4.24969
Norton TD, Skeete F, Dubrovskaya Y, Phillips MS, Bosco JD, 3rd, Mehta SA. Orthopedic surgical site infections: analysis of causative bacteria and implications for antibiotic stewardship. Am J Orthop (Belle Mead NJ). 2014;43(5):E89-92.
Xu H, Yang J, Xie J, Huang Z, Huang Q, Cao G, et al. Efficacy and safety of intrawound vancomycin in primary hip and knee arthroplasty: a systematic review and meta-analysis: implications for the design of a randomized controlled trial. Bone & Joint Research. 2020;9(11):778-88.
https://doi.org/10.1302/2046-3758.911.BJR-2020-0190.R2
Wang F, Zhou H, Olademehin OP, Kim SJ, Tao P. Insights into Key Interactions between Vancomycin and Bacterial Cell Wall Structures. ACS Omega. 2018;3(1):37-45.
https://doi.org/10.1021/acsomega.7b01483
Hey HWD, Thiam DW, Koh ZSD, Thambiah JS, Kumar N, Lau L-L, et al. Is intraoperative local vancomycin powder the answer to surgical site infections in spine surgery? Spine. 2017;42(4):267-74.
https://doi.org/10.1097/BRS.0000000000001710
Heckmann ND, Mayfield CK, Culvern CN, Oakes DA, Lieberman JR, Della Valle CJ. Systematic review and meta-analysis of intrawound vancomycin in total hip and total knee arthroplasty: a call for a prospective randomized trial. The Journal of arthroplasty. 2019;34(8):1815-22.
https://doi.org/10.1016/j.arth.2019.03.071
Patel NN, Guild III GN, Kumar AR. Intrawound vancomycin in primary hip and knee arthroplasty: a safe and cost-effective means to decrease early periprosthetic joint infection. Arthroplasty today. 2018;4(4):479-83.
https://doi.org/10.1016/j.artd.2018.07.011
Burns AW, Chao T, Tsai N, Lynch JT, Smith PN. The use of intra-articular vancomycin is safe in primary hip and knee arthroplasty. Journal of Orthopaedics. 2023;46:161-3.
https://doi.org/10.1016/j.jor.2023.10.017
Dial BL, Lampley AJ, Green CL, Hallows R. Intrawound vancomycin powder in primary total hip arthroplasty increases rate of sterile wound complications. Hip & pelvis. 2018;30(1):37-44.
https://doi.org/10.5371/hp.2018.30.1.37
Tahmasebi MN, Vaziri AS, Vosoughi F, Tahami M, Khalilizad M, Rabie H. Low post-arthroplasty infection rate is possible in developing countries: long-term experience of local vancomycin use in Iran. Journal of Orthopaedic Surgery and Research. 2021;16(1):1-7.
https://doi.org/10.1186/s13018-021-02344-2
Lovallo JL, Murray RS, Wiesel BB, Curley AJ, Conroy CM, Johnson DC. Intraoperative Intra-articular Antibiotic Injection Reduces Infection in Shoulder Arthroplasty. Orthopedics. 2023:1-5.
https://doi.org/10.3928/01477447-20230224-06
Kurtz SM, Lau E, Schmier J, Ong KL, Zhao K, Parvizi J. Infection burden for hip and knee arthroplasty in the United States. The Journal of arthroplasty. 2008;23(7):984-91.
https://doi.org/10.1016/j.arth.2007.10.017
Buchalter DB, Teo GM, Kirby DJ, Schwarzkopf R, Aggarwal VK, Long WJ. Does the organism profile of periprosthetic joint infections change with a topical vancomycin powder and dilute povidone-iodine lavage protocol? The Journal of Arthroplasty. 2021;36(7):S314-S9.
https://doi.org/10.1016/j.arth.2020.12.036
Argenson JN, Arndt M, Babis G, Battenberg A, Budhiparama N, Catani F, et al. Hip and knee section, treatment, debridement and retention of implant: proceedings of international consensus on orthopedic infections. The Journal of arthroplasty. 2019;34(2):S399-S419.
https://doi.org/10.1016/j.arth.2018.09.025
Yavuz IA, Oken OF, Yildirim AO, Inci F, Ceyhan E, Gurhan U. No effect of vancomycin powder to prevent infection in primary total knee arthroplasty: a retrospective review of 976 cases. Knee Surgery, Sports Traumatology, Arthroscopy. 2020;28:3055-60.
https://doi.org/10.1007/s00167-019-05778-8
Xu X, Zhang X, Zhang Y, Chen C, Yu H, Xue E. Role of intra-wound powdered vancomycin in primary total knee arthroplasty. Orthopaedics & Traumatology: Surgery & Research. 2020;106(3):417-20.
https://doi.org/10.1016/j.otsr.2020.01.007
Hanada M, Nishikino S, Hotta K, Furuhashi H, Hoshino H, Matsuyama Y. Intrawound vancomycin powder increases post-operative wound complications and does not decrease periprosthetic joint infection in primary total and unicompartmental knee arthroplasties. Knee Surgery, Sports Traumatology, Arthroscopy. 2019;27:2322-7.
https://doi.org/10.1007/s00167-019-05498-z
Wong MT, Sridharan SS, Davison EM, Ng R, Desy NM. Can topical vancomycin prevent periprosthetic joint infection in hip and knee arthroplasty? A systematic review. Clinical Orthopaedics and Related Research. 2021;479(8):1655.
Published
Issue
Section
License
Copyright (c) 2024 Galen Medical Journal
This work is licensed under a Creative Commons Attribution 4.0 International License.
