Doxey Stephen A, Urdahl Torben H, Solaiman Rafat H, Wegner Mariah N, Parikh Harsh, Cunningham Brian P, Horst Patrick K
Department of Orthopaedic Surgery, TRIA Orthopaedic Institute, Bloomington, MN, USA; Department of Orthopaedic Surgery, Park Nicollet Methodist Hospital, St. Louis Park, MN, USA.
Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA.
Knee. 2024 Dec;51:312-319. doi: 10.1016/j.knee.2024.10.008. Epub 2024 Oct 30.
The purpose of this retrospective analysis of a prospective quality control project was to determine whether the use of intrawound vancomycin powder (IVP) decreases the rate prosthetic joint infection (PJI) within 90-days following primary total knee arthroplasty (TKA).
From October 2021-September 2022, a prospective quality control project was undertaken in which 10 high-volume arthroplasty surgeons alternated between using IVP and not using IVP each month. Patients who received IVP were compared to those who did not. The primary outcome was culture positive PJI within 90-days following primary total knee arthroplasty. Secondary outcomes included overall reoperation rate, wound complications, and readmission within 90-days post-operatively.
A total of 1,317 primary TKA patients were identified for analysis. Fifty-six and seven tenths percent (n = 747) of patients were included in the IVP group and 43.3% (n = 570) patients were included in the non-IVP group. The overall PJI rate was 0.5%. There was no difference in 90-day culture positive PJI rates between the groups (0.7% vs. 0.2%, p = 0.24). The overall reoperation rate did not differ between the IVP and non-IVP group (6.4% vs. 4.6%, p = 0.15). Reoperation for suspected infection was not statistically different by IVP administration (1.2% vs. 0.5%, p = 0.25). Additionally, there were no differences in the incidence of wound complications (p = 0.80) or readmissions (p = 0.15).
The overall infection rate for this cohort was low. IVP was not associated with decreased culture positive PJI, wound complications, reoperation or readmission rates. Further analysis of IVP use in TKA should be undertaken to fully determine its efficacy and safety profile.
本项针对一项前瞻性质量控制项目的回顾性分析，旨在确定在初次全膝关节置换术（TKA）后90天内，使用伤口内万古霉素粉末（IVP）是否能降低人工关节感染（PJI）的发生率。
2021年10月至2022年9月，开展了一项前瞻性质量控制项目，10位高手术量的关节置换外科医生每月交替使用或不使用IVP。将接受IVP的患者与未接受IVP的患者进行比较。主要结局是初次全膝关节置换术后90天内培养阳性的PJI。次要结局包括总体再次手术率、伤口并发症以及术后90天内的再入院情况。
共纳入1317例初次TKA患者进行分析。IVP组纳入患者占56.7%（n = 747），非IVP组纳入患者占43.3%（n = 570）。总体PJI发生率为0.5%。两组间90天培养阳性PJI发生率无差异（0.7%对0.2%，p = 0.24）。IVP组和非IVP组的总体再次手术率无差异（6.4%对4.6%，p = 0.15）。因疑似感染进行再次手术在IVP使用与否方面无统计学差异（1.2%对0.5%，p = 0.25）。此外，伤口并发症发生率（p = 0.80）或再入院率（p = 0.15）也无差异。
该队列的总体感染率较低。IVP与培养阳性PJI发生率降低、伤口并发症、再次手术或再入院率无关。应进一步分析IVP在TKA中的使用情况，以全面确定其疗效和安全性。
