Otto Aufranc Award: Intraosseous Vancomycin in Total Hip Arthroplasty - Superior Tissue Concentrations and Improved Efficiency.

Autor: Harper KD; Department of Orthopedic Surgery, Washington DC VA Medical Center, Washington, District of Columbia., Park KJ; Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, Texas., Brozovich AA; Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, Texas; Center for Musculoskeletal Regeneration, Houston Methodist Research Institute, Houston, Texas., Sullivan TC; Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, Texas., Serpelloni S; Center for Musculoskeletal Regeneration, Houston Methodist Research Institute, Houston, Texas., Taraballi F; Center for Musculoskeletal Regeneration, Houston Methodist Research Institute, Houston, Texas., Incavo SJ; Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, Texas., Clyburn TA; Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, Texas.
Jazyk: angličtina
Zdroj: The Journal of arthroplasty [J Arthroplasty] 2023 Jul; Vol. 38 (7S), pp. S11-S15. Date of Electronic Publication: 2023 Apr 23.
DOI: 10.1016/j.arth.2023.04.028
Abstrakt: Background: Literature shows that intraosseous (IO) infusions are capable of providing increased local concentrations compared to those administered via intravenous (IV) access. Successes while using the technique for antibiotic prophylaxis administration in total knee arthroplasty (TKA) prompted consideration for use in total hip arthroplasty (THA) however; no study exists for the use of IO vancomycin in THA.
Methods: This single-blinded randomized control trial was performed from December 2020 to May 2022. Twenty patients were randomized into 1 of 2 groups: IV vancomycin (15 mg/kg) given routinely, or IO vancomycin (500 mg/100cc of NS) injected into the greater trochanter during incision. Serum vancomycin levels were collected at incision and closure. Soft tissue vancomycin levels were taken from the gluteus maximus (at start and end of case), and acetabular pulvinar tissue. Bone vancomycin levels were taken from the femoral head, acetabular reamings, and intramedullary bone. Adverse local/systemic reactions, 30-day complications, and 90-day complications were also tracked.
Results: A statistically significant reduction in serum vancomycin levels was seen when comparing IO to IV vancomycin at both the start and at the end of the procedure. All local tissue samples had higher concentrations of vancomycin in the IO group. Statistically significant increases were present within the acetabular bone reamings, and approached significance in intramedullary femoral bone.
Conclusion: This study demonstrates the utility of IO vancomycin in primary THA with increased local tissue and decreased systemic concentrations. With positive findings in an area without tourniquet use, IO may be considered for antibiotic delivery for alternative procedures.
(Published by Elsevier Inc.)
Databáze: MEDLINE
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