A multicenter clinical study on intramedullary vancomycin injection for preventing periprosthetic joint infection in total knee arthroplasty
10.3760/cma.j.cn121113-20241216-00728
- VernacularTitle:骨髓腔注射万古霉素预防全膝关节置换感染的多中心临床研究
- Author:
Te LIU
1
;
Jun FU
;
Shiguang LAI
;
Zhuo ZHANG
;
Chi XU
;
Lei GENG
;
Yang LUO
;
Peng REN
;
Xin ZHI
;
Quanbo JI
;
Heng ZHANG
;
Runkai ZHAO
;
Haichao REN
;
Ye TAO
;
Qingyuan ZHENG
;
Zeyu FENG
;
Jianfeng YANG
;
Yiming WANG
;
Pengcheng LI
;
Shuai LIU
;
Wei CHAI
;
Xiang LI
;
Huiwu LI
;
Xiaogang ZHANG
;
Baochao JI
;
Xianzhe LIU
;
Xinzhan MAO
;
Jianbing MA
;
Xiangxiang SUN
;
Jiying CHEN
;
Yonggang ZHOU
;
Jinliang WANG
;
Weijun WANG
;
Guoqiang ZHANG
;
Ming NI
Author Information
1. 中国人民解放军总医院第四医学中心骨科医学部，北京 100048
- Publication Type:Journal Article
- Keywords:
Total knee arthroplasty;
Periprosthetic joint infection;
Intraosseous regional administration;
Vancomycin
- From:
Chinese Journal of Orthopaedics
2025;45(12):803-811
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the safety and efficacy of intraosseous regional administration (IORA) of vancomycin for preventing infection in primary total knee arthroplasty (TKA).Methods:A total of 124 patients with knee osteoarthritis undergoing TKA between February 2024 and May 2024 at nine hospitals were enrolled. Preoperative infection prophylaxis involved either IORA (0.5 g vancomycin administered via intraosseous regional infusion before incision) or intravenous infusion (1 g vancomycin via peripheral vein). The IORA group included 15 males and 47 females with a median age of 66.5 years (range, 60.0-70.0 years), while the intravenous group included 14 males and 48 females with a median age of 66.0 years (range, 61.8-70.3 years) years. Intraoperative samples were collected including fat and synovium tissues after incision, before prosthesis placement, and after tourniquet release; distal femoral cancellous bone during femoral osteotomy; proximal tibial cancellous bone during tibial osteotomy; proximal intercondylar cancellous bone before prosthesis placement; and peripheral blood from non-infused arms at surgery initiation and after tourniquet release. Vancomycin concentrations were measured using liquid chromatography-tandem mass spectrometry. Vital sign changes were recorded from admission to 5~10 minutes post-IORA (IORA group) or post-incision (intravenous group). Follow-ups were conducted on postoperative day 1 and 3, and at 1 and 3 months, to document complications including IORA-related adverse events, periprosthetic joint infections, surgical site infections, red man syndrome, acute kidney injury, deep vein thrombosis and so on.Results:Vancomycin concentrations in bone, fat, and synovial tissue samples were significantly higher in the IORA group than in the intravenous group ( P<0.05), while vancomycin concentrations in blood samples were significantly lower in the IORA group than in the intravenous group ( P<0.05). Only 7.3%(41/558) of tissue samples in the IORA group had vancomycin concentrations below 2.0 μg/g (the minimum inhibitory concentration of vancomycin against coagulase-negative staphylococcus), compared to 59.3%(331/558) in the intravenous group (χ 2=11.285, P<0.001). In the intravenous group, 16.9%(21/124) of blood samples had vancomycin concentrations exceeding 15.0 mg/L (the threshold associated with a significantly increased risk of nephrotoxicity), while all concentrations in the IORA group were below this threshold, the difference was statistically significant (χ 2=22.943, P<0.001). There were no statistically significant difference ( P>0.05) in vital signs changes before and after vancomycin administration between the two groups. Two patients in the intravenous group experienced incision exudate, while no other related complications occurred in either group. Conclusions:Compared to the traditional intravenous infusion of 1 g vancomycin, intraosseous injection of a low dose (0.5 g) of vancomycin achieves higher local tissue concentrations in the knee joint with a lower incidence of adverse reactions and is safe for infection prophylaxis. Despite guidelines not recommending the routine use of vancomycin for preventing infection after primary TKA, intraosseous injection of 0.5 g vancomycin may be considered intraoperatively for primary TKA in the following scenarios: patients in medical institutions with a high prevalence of methicillin-resistant staphylococcus aureus (MRSA) infections, patients with potential preoperative MRSA colonization, or patients with cephalosporin allergy.
