LONG-TERM OUTCOMES OF INTRAOPERATIVE VANCOMYCIN POWDER APPLICATION IN ELECTIVE HIP SURGERY

Aim The long-term efficacy of intraoperative vancomycin powder (IVP) application as a prophylactic strategy against prosthetic joint infection in elective hip surgery remains a subject of ongoing debate. This study aims to assess the five-year outcomes in patients undergoing total hip arthroplasty (THA) or aseptic revision, comparing those who received IVP with those who did not. Method A retrospective analysis was conducted on a cohort of patients prospectively enrolled at the time of surgery. Patients undergoing non-elective hip arthroplasty due to fracture or septic intervention were excluded, as were those who deceased or were lost to follow-up within the defined study period. The primary outcome was treatment failure, defined as the requirement for revision surgery or long-term suppressive antibiotic therapy within five years postoperatively. Statistical analysis was performed to compare failure rates between the IVP and non-IVP groups. Results A total of 304 patients met the inclusion criteria, comprising 244 primary THAs and 60 aseptic revision procedures. Of these, 121 patients received IVP, while 183 did not. The overall failure rate was 8.2% (25 patients), with a rate of 2.3% (7 patients) in the IVP group and 5.9% (18 patients) in the non-IVP group. However, the difference between the two groups was not statistically significant (p = 0.208), and thus no definitive protective effect of IVP could be established. Conclusions The findings suggest that the intraoperative application of vancomycin powder in primary or aseptic revision THA does not confer a statistically significant benefit in reducing the risk of revision surgery or the need for suppressive therapy at five years. In light of these results, the routine use of IVP for infection prophylaxis in elective hip arthroplasty should be reconsidered.