CAN INTRA-ARTICULAR VANCOMYCIN BE USED TO DECREASE THE INCIDENCE OF PROSTHETIC JOINT INFECTION? PRELIMINARY ANALYSIS FROM A RANDOMIZED CONTROLLED TRIAL

Ongoing efforts aim to reduce infection rates associated with total joint replacement, as these infections have significant adverse effects on both patients and healthcare systems. Topical vancomycin has been utilized for its broad-spectrum efficacy against both anaerobic and aerobic gram-positive bacteria in the prevention of prosthetic joint infections (PJI). However, its application remains controversial due to the limited prospective data supporting its routine use. The objective of this study is to evaluate the effectiveness of topical vancomycin in decreasing the incidence of deep PJIs and to assess any potential complications associated with its application. A randomized prospective trial was conducted for all arthroplasty cases performed by six fellowship-trained surgeons in a single university center. The inclusion criteria encompassed patients undergoing primary and revision arthroplasty of the knee and hip. Participants were randomly assigned to two groups: one receiving vancomycin powder prior to closure (intervention group) and the other not receiving vancomycin (control group). For patients undergoing bilateral joint arthroplasty, each joint was treated as a separate procedure for randomization purposes. All patients were administered a pre-operative dose of IV antibiotics. The primary outcome was the incidence of deep infection at 90 days post-operation. Additional complications were also recorded. A power analysis indicated that a sample size of 1,834 patients was necessary to achieve adequate statistical power. As of this date, a total of 643 patients have been included in the study, consisting of 327 women (51%) and 316 men (49%). The cohort is comprised of 316 primary hip arthroplasties (49%), 21 hip revisions (3%), 277 primary knee arthroplasties, and 28 knee revisions (4%). Vancomycin was administered to 318 patients (49%), while 325 patients (51%) were randomized to the control group. Deep infections were identified in 4 patients (0.6%) and were all in the control group (p=0.049). The incidence of superficial infections was not significantly different between groups (13 cases were in the control group, while 10 were in the vancomycin group, p = 0.269). Although significant, the difference in deep infection remains statistically fragile. We believe these results to be promising and noteworthy. The randomization will continue until robust results are obtained or until sample size is achieve if no difference is noted.