Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL.
Keck School of Medicine of the University of Southern California, Los Angeles, CA.
J Arthroplasty. 2019 Aug;34(8):1815-1822. doi: 10.1016/j.arth.2019.03.071. Epub 2019 Apr 1.
Topical intrawound vancomycin has been used extensively in spine surgery to decrease surgical site infections. However, the efficacy of intrawound vancomycin in total hip (THA) and total knee arthroplasty (TKA) to prevent periprosthetic joint infection (PJI) has not been established.
The PubMed and MEDLINE databases were searched to identify studies utilizing intrawound vancomycin in primary and revision THA and TKA. Data for postoperative infection were pooled using random effect models with results reported as odds ratios (ORs) and 95% confidence intervals. Studies were weighted by the inverse variance of their effect estimates.
Of the 91 studies identified, 6 low-quality retrospective studies (level III) were pooled for further analysis. A total of 3298 patients were assessed, 1801 of which were treated with intrawound vancomycin. Overall, patients who received vancomycin had a decreased rate of PJI (OR 0.2530, P < .0001). When analyzed separately, TKA patients and THA patients who received intrawound vancomycin had lower rates of PJI (OR 0.3467, P = .0005 and OR 0.3672, P = .0072, respectively). Pooled primary TKA and THA patients receiving vancomycin saw the rate of PJI decrease (OR 0.4435, P = .0046). Pooled revision TKA and THA patients saw a similar decrease in infection rates (OR 0.2818, P = .0013). No apparent publication bias was observed; however, the results from this analysis are limited by the low quality of evidence and inherent potential for bias.
Intrawound vancomycin may reduce the risk of PJI in primary and revision TKA and THA. However, only low-quality evidence exists, highlighting the need for randomized controlled trials before broad adoption of this practice can be recommended given the potential implications of widespread use of vancomycin in hip and knee arthroplasty.
局部创面万古霉素在脊柱外科中被广泛用于减少手术部位感染。然而，在全髋关节置换术（THA）和全膝关节置换术（TKA）中，局部使用万古霉素预防假体周围关节感染（PJI）的疗效尚未确定。
检索 PubMed 和 MEDLINE 数据库，以确定在初次和翻修 THA 和 TKA 中使用局部创面万古霉素的研究。使用随机效应模型汇总术后感染数据，结果以比值比（OR）和 95%置信区间（CI）报告。研究结果按其效应估计值的倒数进行加权。
在确定的 91 项研究中，有 6 项低质量的回顾性研究（III 级）被纳入进一步分析。共评估了 3298 例患者，其中 1801 例接受了局部创面万古霉素治疗。总体而言，接受万古霉素治疗的患者 PJI 发生率降低（OR 0.2530，P<.0001）。单独分析时，接受局部创面万古霉素治疗的 TKA 患者和 THA 患者的 PJI 发生率较低（OR 0.3467，P=.0005 和 OR 0.3672，P=.0072）。接受局部创面万古霉素治疗的原发性 TKA 和 THA 患者的 PJI 发生率降低（OR 0.4435，P=.0046）。接受局部创面万古霉素治疗的翻修 TKA 和 THA 患者的感染率也有类似降低（OR 0.2818，P=.0013）。未观察到明显的发表偏倚，但由于广泛使用万古霉素对髋膝关节置换术的潜在影响，该分析结果受到证据质量低和固有偏倚的限制。
局部创面万古霉素可能降低初次和翻修 TKA 和 THA 中 PJI 的风险。然而，目前仅有低质量的证据，在广泛推荐这种治疗方法之前，需要随机对照试验来证实，因为广泛使用万古霉素对髋膝关节置换术可能产生广泛的影响。
