Johnson Jeremiah D, Nessler Joseph M, Horazdovsky Ryan D, Vang Sandy, Thomas Avis J, Marston Scott B
Department of Orthopaedic Surgery, Regions Hospital, St. Paul, Minnesota; Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota.
Creighton University School of Medicine, Omaha, Nebraska.
J Arthroplasty. 2017 Mar;32(3):924-928. doi: 10.1016/j.arth.2015.10.015. Epub 2015 Oct 26.
Periprosthetic joint infection is the most common cause of readmissions after total joint arthroplasty (TJA). Intrawound vancomycin powder (VP) has reduced infection rates in spine surgery; however, there are no data regarding VP in primary TJA.
Thirty-four TJA patients received 2 g of VP intraoperatively to investigate VP's pharmacokinetics. Serum and wound concentrations were measured at multiple intervals over 24 hours after closure.
All serum concentrations were subtherapeutic (<15μg/mL) and peaked 12 hours after closure (4.7μg/mL; standard deviation [SD], 3.2). Wound concentrations were 922 μg/mL (SD, 523) 3 hours after closure and 207 μg/mL (SD, 317) at 24 hours. VP had a half-life of 7.2 hours (95% confidence interval, 7.0-9.3) in TJA wounds.
VP produced highly therapeutic intrawound concentrations while yielding low systemic levels in TJA. VP may serve as a safe adjunct in the prevention of periprosthetic joint infection.
人工关节周围感染是全关节置换术（TJA）后再次入院的最常见原因。伤口内注射万古霉素粉末（VP）可降低脊柱手术的感染率；然而，关于原发性TJA中VP的数据尚无报道。
34例TJA患者术中接受2g VP以研究VP的药代动力学。在伤口闭合后24小时内的多个时间点测量血清和伤口浓度。
所有血清浓度均低于治疗水平（<15μg/mL），并在伤口闭合后12小时达到峰值（4.7μg/mL；标准差[SD]，3.2）。伤口闭合后3小时的伤口浓度为922μg/mL（SD，523），24小时时为207μg/mL（SD，317）。VP在TJA伤口中的半衰期为7.2小时（95%置信区间，7.0-9.3）。
VP在TJA中产生了高治疗性的伤口内浓度，同时全身水平较低。VP可作为预防人工关节周围感染的安全辅助手段。
