Effects of different doses of vancomycin powder in total knee and hip arthroplasty on the periprosthetic joint infection rate: a systematic review and meta-analysis

Abstract

Background Periprosthetic joint infection (PJI) following total joint arthroplasty (TJA) is a serious complication for patients. Some joint surgeons have tried to use vancomycin powder (VP) in total knee and total hip arthroplasty to prevent postoperative PJI, but its effect is still not clear. At present, there is no meta-analysis that specifically analyses the effect of different doses of vancomycin powder on the incidence of PJI. Methods We carried out a search based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and identified the studies we needed. Review Manager (RevMan) 5.3 software was employed for statistical analysis. Results The analysis of primary TKA (PTKA) showed that using 1 g (RR 0.38, 95% CI 0.22–0.67 [P = 0.0008]) and 2 g (RR 0.48, 95% CI 0.31–0.74 [P = 0.0008]) of vancomycin powder in primary TKA (PTKA) could all significantly prevent PJI. The analysis of primary THA (PTHA) showed that using 1 g (RR 0.37, 95% CI 0.17–0.80 [P = 0.01]) of vancomycin powder effectively decreased the incidence of PJI, while using 2 g (RR 1.02, 95% CI 0.53–1.97 [P = 0.94]) of vancomycin powder had no significant effect on preventing PJI. Because the data were abnormal, we believed the conclusion that using 2 g of vancomycin powder in primary THA had no effect on preventing PJI was doubtful. Using vancomycin powder in revision TKA (RTKA) significantly reduced the PJI rate (RR 0.33, 95% CI 0.14–0.77 [P = 0.01]), similar to revision THA (RTHA) (RR 0.37, 95% CI 0.14–0.96 [P = 0.04]). Conclusions In primary TKA, both 1 g and 2 g of vancomycin powder can effectively prevent PJI. In primary THA, using 1 g of vancomycin powder is a better choice, while the effect of using 2 g of vancomycin powder is not clear, and a more prospective randomized controlled trial should be done to verify it. In revision TKA and revision THA, vancomycin powder is a good choice to prevent PJI.

Use of topical vancomycin powder in total joint arthroplasty: Why the current literature is inconsistent?

“…Similarly, Liao et al [ 43 ], published in strong favor of VP suggesting that VP has a clear effect on preventing PJI in primary TKA. The authors reported on 11292 TKA where VP was used with a Risk Ratio (RR) of 0.41 (95%CI 0.29 to 0.58, P < 0.001) when compared to cases where VP was not used.…”

Vancomycin powder in total joint replacement

“…Its use in combination with vancomycin powder makes it difficult, if not impossible, to differentiate statistically between the effect of vancomycin and the effect of povidone-iodine. 46-49 Specifically, Liao et al 43 reported similar findings strongly in favour of vancomycin powder. However, 46.7% of their results related once again to studies in which it was used in combination with povidone-iodine solutions.…”