McNamara Colin A, Wininger Austin E, Sullivan Thomas C, Brown Timothy S, Clyburn Terry A, Incavo Stephen J, Park Kwan J
Houston Methodist Hospital, Houston Methodist Orthopedics & Sports Medicine, Houston, Texas; Department of Orthopaedic Surgery, University of Miami, Miami, Florida.
Houston Methodist Hospital, Houston Methodist Orthopedics & Sports Medicine, Houston, Texas.
J Arthroplasty. 2025 Sep;40(9S1):S28-S32. doi: 10.1016/j.arth.2025.04.060. Epub 2025 May 6.
Periprosthetic joint infection (PJI) is a devastating complication following total knee arthroplasty (TKA). Prior literature supports the intraosseous (IO) delivery of vancomycin as a safe and effective technique for primary TKA. The purpose of this study was to evaluate its efficacy for aseptic revision of TKA.
A single-institution retrospective review was performed on patients who underwent aseptic revision TKA from May 2016 to October 2023. Vancomycin was administered through an intravenous (IV) route in 386 cases and via an IO infusion in 333 cases. The IV cohort received a 15 mg/kg dose of vancomycin before skin incision. The IO cohort received a 500 mg dose of vancomycin infused into the tibia after tourniquet inflation. All patients also received a weight-based dose of IV cefazolin perioperatively. Patient characteristics, surgical details, and infection-related data were extracted during chart review. The PJI diagnosis was based on the 2018 Musculoskeletal Infection Society criteria. Fisher's exact tests and Chi-square analyses were used to compare categorical outcomes.
The incidence of PJI was significantly lower in the IO cohort compared to the IV cohort at 30-day (0.3 versus 2.1%, P = 0.03), 90-day (0.9 versus 3.1%, P = 0.04), and 1-year follow-up (1.6 versus 4.9%, P = 0.04). There were no reported adverse reactions to vancomycin. There were no differences in the incidence of acute kidney injury (2.7 versus 2.9%, P = 0.90), deep venous thrombosis (1.2 versus 1.8%, P = 0.56), or pulmonary embolism (0 versus 0.3%, P = 1.0) between groups.
Use of IO vancomycin infusion is a safe and effective alternative to IV administration for patients undergoing aseptic revision TKA. Furthermore, IO vancomycin optimized the efficiency of vancomycin administration in this high-risk surgical cohort and resulted in a significant reduction in the rate of PJI through 1-year follow-up.
人工关节周围感染（PJI）是全膝关节置换术（TKA）后一种严重的并发症。既往文献支持万古霉素的骨内（IO）给药作为初次TKA的一种安全有效的技术。本研究的目的是评估其在TKA无菌翻修中的疗效。
对2016年5月至2023年10月接受TKA无菌翻修的患者进行单机构回顾性研究。386例患者通过静脉（IV）途径给予万古霉素，333例患者通过IO输注给予万古霉素。IV组在皮肤切开前接受15mg/kg剂量的万古霉素。IO组在止血带充气后将500mg剂量的万古霉素注入胫骨。所有患者在围手术期还接受了基于体重的静脉注射头孢唑林剂量。在病历审查过程中提取患者特征、手术细节和感染相关数据。PJI诊断基于2018年肌肉骨骼感染学会标准。采用Fisher精确检验和卡方分析比较分类结果。
在30天（0.3%对2.1%，P = 0.03）、90天（0.9%对3.1%，P = 0.04）和1年随访时（1.6%对4.9%，P = 0.04），IO组的PJI发生率显著低于IV组。未报告对万古霉素的不良反应。两组之间急性肾损伤发生率（2.7%对2.9%，P = 0.90）、深静脉血栓形成（1.2%对1.8%，P = 0.56）或肺栓塞（0对0.3%，P = 1.0）无差异。
对于接受TKA无菌翻修的患者，使用IO万古霉素输注是一种安全有效的替代静脉给药的方法。此外，IO万古霉素优化了该高风险手术队列中万古霉素的给药效率，并通过1年随访显著降低了PJI发生率。
