Intraosseous Vancomycin Reduces periprosthetic joint infecti
Increasing incidence of methicillin-resistant Staphylococcus aureus (MRSA) is a particular concern. The use of vancomycin as prophylactic agent alone or in combination with cephalosporin has not demonstrated lower periprosthetic joint infection (PJI) rates, partly due to timing and dosing of intravenous (IV) vancomycin administration, which have proven important factors in effectiveness. This retrospective review examined incidence of PJI, adverse reactions, and complications using IV versus intraosseous (IO) vancomycin at 30-day, 90-day, and one-year follow-up.

A retrospective review of 1,060 patients who underwent TKA was performed. There were 572 patients in the IV group and 488 in the IO group, with minimal 30 days of follow-up. Patients were followed up at regularly scheduled intervals. The IV group received an IV dose of 15 mg/kg vancomycin given over an hour preceding skin incision. The IO group received a 500 mg dose of vancomycin mixed in 150 ml of normal saline, injected into proximal tibia after tourniquet inflation, before skin incision. All patients received an additional dose of first generation cephalosporin.

--Incidence of PJI with minimum 90-day follow-up was 1.4% (8 knees) in the IV group and 0.22% (1 knee) in IO group.

--This preliminary report demonstrated an reduction in the incidence of infection in TKA using IO vancomycin combined with a first-generation cephalosporin.

--While the study suffers from limitations of a retrospective, multi-surgeon investigation, early findings are encouraging.

In particular, IO delivery of vancomycin after tourniquet inflation is a Safe and Effective alternative to IV administration, eliminating the logistical challenges of timely dosing.