Intrawound vancomycin powder in primary total knee arthroplasty: A multi-center study on early postoperative infection rates

Abstract

Objective: This study evaluates the impact of intrawound vancomycin powder on early postoperative infection rates in primary total knee arthroplasty (TKA). A total of 377 primary TKA cases were analyzed, including 256 cases from our center and 121 cases from a collaborating center. Patients were divided into two groups: one receiving intrawound vancomycin powder and the other receiving no adjunctive therapy. Results were analyzed to assess infection rates within 90 days postoperatively. Methods: A retrospective cohort study was conducted. Both centers employed fellowship-trained arthroplasty surgeons, and all surgeries followed standardized protocols. Patients were divided into two groups: vancomycin (1g) applied to the wound at closure and a control group that received standard antibiotic prophylaxis (cefazolin). All patients received antibiotic-impregnated cement. Infection rates within 90 days post-surgery were analyzed using Chi-square tests to determine statistical significance. Results: Of 377 cases, 189 were in the vancomycin group and 188 in the control group. Infection rates were 2.1% in the vancomycin group and 2.4% in the control group. Statistical analysis revealed no significant difference (p = 0.83). Conclusion: The use of intrawound vancomycin powder in primary TKA did not significantly reduce early postoperative infections. Further prospective studies with larger sample sizes and longer follow-up periods are warranted to confirm these findings.