[Intraosseous vancomycin in total knee arthroplasty].

Autor: Martínez WF; Pontificia Universidad Católica Argentina, Facultad de Medicina. Buenos Aires, Argentina; Grupo GRECARO., Tillet F; Clínica San Camilo. Ciudad Autónoma de Buenos Aires, Argentina; Grupo GRECARO., Bochatey EJ; Instituto de Tratamiento y Rehabilitación Articular, Instituto Argentino de Diagnóstico y Tratamiento. Ciudad Autónoma de Buenos Aires, Argentina; Grupo GRECARO., Lopreite FA; Servicio de Ortopedia y Traumatología, Hospital Británico de Buenos Aires, Instituto Argentino de Diagnóstico y Tratamiento. Ciudad Autónoma de Buenos Aires, Argentina; Grupo GRECARO.
Jazyk: Spanish; Castilian
Zdroj: Acta ortopedica mexicana [Acta Ortop Mex] 2024 May-Jun; Vol. 38 (3), pp. 172-178.
DOI: 10.35366/115812
Abstrakt: Introduction: intravenous antibiotic prophylaxis has significantly reduced the incidence of periprosthetic joint infection (PJI) in knee surgeries. However, for patients colonized with methicillin-resistant Staphylococcus aureus (MRSA) or those at risk of colonization, prophylaxis should include vancomycin. Intraosseous (IO) administration of vancomycin could enhance its effectiveness in total knee arthroplasty (TKA).
Material and Methods: a retrospective review was conducted, including 143 patients at risk of PJI scheduled for TKA who received IO vancomycin along with intravenous (IV) cefazolin, referred to as group I (GI), between May 2021 and December 2022. The occurrence of complications in the first three postoperative months was evaluated. Results were compared with 140 patients without risk factors who received standard IV prophylaxis, designated as group II (GII).
Results: in GI, 500 mg of IO vancomycin was administered, injected into the proximal tibia, in addition to standard IV prophylaxis. In GII, patients received only IV cefazolin. The incidence of complications was 1.64% in GI and 1.4% in GII. The PJI rate at 90 postoperative days was 0.69% in GI and 0.71% in GII.
Conclusions: IO vancomycin administration, along with standard IV prophylaxis, provides a safe and effective alternative for patients at risk of MRSA colonization. This approach minimizes complications associated with IV vancomycin use and addresses logistical challenges of timely administration.
Databáze: MEDLINE
Externí odkaz: