Vancomycin Prophylaxis for Total Joint Arthroplasty: Incorrectly Dosed and Has a Higher Rate of Periprosthetic Infection Than Cefazolin

Kheir, Michael M.; Tan, Timothy L.; Azboy, İbrahim; Tan, Dean D.; Parvızı, Javad

doi:10.1007/s11999-017-5302-0

Cited by 102 publications

(68 citation statements)

References 31 publications

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“…As the number of TJAs increases, the rate of complications may rise. Infections after TJA despite antibiotic prophylaxis occur in approximately 1% to 2% of cases . Beside infections, other implant‐related complications such as malalignment, loosening, skin changes, pain and swelling may occur.…”

Section: Introductionmentioning

confidence: 99%

“…Infections after TJA despite antibiotic prophylaxis occur in approximately 1% to 2% of cases. 5 Beside infections, other implant-related complications such as malalignment, loosening, skin changes, pain and swelling may occur. One potential cause that has been widely discussed is a hypersensitivity reaction to a metal or bone cement component.…”

Section: Introductionmentioning

confidence: 99%

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Metal hypersensitivity in patients with orthopaedic implant complications—A retrospective clinical study

et al. 2018

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Background Hypersensitivity to metals as a cause of implant‐related complications has been a subject of controversy. Projections indicate an increase in the frequency of joint replacements of between 300% and 600% by the year 2030; therefore, this issue is of considerable interest. Objective To evaluate sensitization to implant materials in patients with implant‐related complications, to identify allergens, and to clarify whether hypersensitivity is a relevant cause. Methods Patients with implant‐related complications or a positive history of contact allergy and planned total joint replacements referred for allergological investigation between 2004 and 2017 were retrospectively analysed. Results In total, 311 patients were included. A positive patch test reaction to a metal was seen in 64.4% of preoperative patients and in 54.6% of patients with implant‐related complications. Common alloy metals such as cobalt, chromium and titanium gave positive reactions in up to 2.9% of patients with implant‐related complications. None of the patients with skin changes had a positive patch test reaction to an implant metal. Conclusion Other factors, such as the type of replaced joint and mechanical stress, seem to be more relevant for implant‐related complications. Sensitization to metals or other materials seems to rarely play a role, and is overestimated.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Metal hypersensitivity in patients with orthopaedic implant complications—A retrospective clinical study

et al. 2018

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“…Optimal antibiotic selection and dosages specifically for TJA, however, remain controversial. For instance, a recent large database study noted a 32% higher risk of PJI when noncephalosporin antibiotics such as vancomycin were used for preoperative prophylaxis 7,47,48 . This may be due to issues such as weight‐based underdosage or improper administration protocols 48 .…”

Section: New Advancements In Prevention Of Pjimentioning

confidence: 99%

New developments and future challenges in prevention, diagnosis, and treatment of prosthetic joint infection

Ricciardi

Muthukrishnan

Masters

et al. 2020

Journal Orthopaedic Research

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Prosthetic joint infection (PJI) is a devastating complication that results in substantial costs to society and patient morbidity. Advancements in our knowledge of this condition have focused on prevention, diagnosis, and treatment, in order to reduce rates of PJI and improve patient outcomes. Preventive measures such as optimization of patient comorbidities, and perioperative antibiotic usage are intensive areas of current clinical research to reduce the rate of PJI. Improved diagnostic tests such as synovial fluid (SF) α‐defensin enzyme‐linked immunosorbent assay, and nucleic acid‐based tests for serum, SF, and tissue cultures, have improved diagnostic accuracy and organism identification. Increasing the diversity of available antibiotic therapy, immunotherapy, and alternative implant coatings remain promising treatments to improve infection eradication in the setting of PJI.

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“…The brief and erratic nature by which bone cement elutes antibiotics into the articular space further impairs their antimicrobial effectiveness [28]. Furthermore, in addition to resistance against antibiotics within bone cement, recent serological studies of patients undergoing TJA have shown that when intravenous vancomycin is given before surgery to prophylactically prevent PJI, the dose given is either insufficient to achieve proper bacteriostatic concentrations [29], or is high enough to cause acute kidney injury [30]. Therefore, significant efforts are needed both to improve the use of antibiotics within bone cement and systemically to prevent the onset of PJI.…”

Section: The Pathophysiology Of Pji: the Periprosthetic Environment Amentioning

confidence: 99%

Current Options and Emerging Biomaterials for Periprosthetic Joint Infection

et al. 2018

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Recent advancements in local antibiotic delivery platforms for preventing and treating PJI include titanium nanotube arrays, synthetic polymers, resorbable hydrogels, and cyclodextrin-based drug delivery options. In particular, cyclodextrins have facilitated great advancements in other clinical disorders and have demonstrated early promise as a future option in the arena of PJI. Novel treatment modalities for PJI optimize the implant surfaces to prevent bacterial biofilm formation or provide prolonged intra-articular antibiotic dosing to eradicate bacteria.

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Vancomycin Prophylaxis for Total Joint Arthroplasty: Incorrectly Dosed and Has a Higher Rate of Periprosthetic Infection Than Cefazolin

Abstract: Level III, therapeutic study.

Cited by 102 publications

References 31 publications

Metal hypersensitivity in patients with orthopaedic implant complications—A retrospective clinical study

Metal hypersensitivity in patients with orthopaedic implant complications—A retrospective clinical study

New developments and future challenges in prevention, diagnosis, and treatment of prosthetic joint infection

Current Options and Emerging Biomaterials for Periprosthetic Joint Infection

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