The role of intra-articular vancomycin powder to prevent periprosthetic joint infection (PJI) after total joint arthroplasty (TJA) is unclear. Although vigorous studies have shown a correlation between the use of intrawound vancomycin powder and a decreased rate of surgical site infection1-3, such studies were performed only in spine or trauma settings. Unfortunately, prospective randomized studies require a tremendous effort both financially and in terms of time to fulfill current regulations. Thus, it is important to first address this question through basic-science studies that could guide clinical studies in the future.
The current article describes a rat model in which use of intra-articular vancomycin (at a dose equivalent to 2 g in an 80-kg human) in addition to systemic vancomycin (15 mg/kg) prevented intra-articular methicillin-resistant Staphylococcus aureus (MRSA) infection—i.e., no cultures were positive for MRSA—6 days after simulated PJI and MRSA inoculation. Also, the rate of positive cultures was significantly lower than when no antibiotic or only systemic vancomycin was used. It is important to note that the current model may have shown infection prevention, but demonstration of eradication may require a well-established biofilm model. Also, the authors used a specific MRSA strain, so the effect of the described vancomycin protocol on other bacterial strains cannot be assessed.
The authors concluded that intra-articular vancomycin powder effectively reduced bacterial contamination in a rat model of MRSA TJA contamination. Moreover, when used in combination with systemic therapy, vancomycin completely eliminated bacterial contamination. This work supports the potential clinical use of intra-articular vancomycin powder. It remains unclear whether use of the described protocol in a clinical setting could lead to increased bacterial resistance to vancomycin or the emergence of more virulent PJI. Only prospective studies will clarify this potential issue.
↵* Disclosure: The author indicated that no external funding was received for any aspect of this work. On the Disclosure of Potential Conflicts of Interest form, which is provided with the online version of the article, the author checked “yes” to indicate that the author had a relevant financial relationship in the biomedical arena outside the submitted work.
- Copyright © 2017 by The Journal of Bone and Joint Surgery, Incorporated