2025 ISAKOS Congress in Munich, Germany

2025 ISAKOS Biennial Congress Paper


Infection Rate After Intra-Articular Vancomycin Use in Patients Undergoing Hip or Knee Arthroplasty: A Systematic Review of RCT’S With Meta-Analysis

Vinícius Furtado, Student, Londrina, Paraná BRAZIL
Elcio Machinski, md BRAZIL
André Richard Da Silva Oliveira Filho, Student, Joao Pessoa, Paraiba BRAZIL
Rodrigo Conde, MS ARGENTINA
Bruno Butturi Varone, MD, Sao Paulo BRAZIL
Riccardo Gomes Gobbi, MD, PhD, São Paulo, SP BRAZIL
Camilo P. Helito, MD, PhD, Prof, São Paulo, SP BRAZIL
Daniel Leal, MD, São Paulo, SP BRAZIL

Pontifícia Universidade Católica do Paraná, Londrina, Paraná, BRAZIL

FDA Status Not Applicable

Summary

Intra-articular Vancomycin in Hip/Knee Arthroplasty

Abstract

Background

This meta-analysis evaluated the efficacy of intra-articular vancomycin powder in preventing prosthetic joint infection in primary hip and knee arthroplasties.

Methods

In accordance with PRISMA guideline, a research in Pubmed, Embase and Cochrane databases was performed to identify randomized clinical trials comparing intra-articular vancomycin use to conventional antibiotic prophylaxis in total hip or knee arthroplasty patients, assessing postoperative infection rates, adverse drug reactions, and venous thrombotic events. Statistical analysis was performed using R (RStudio 2024.04.2), and heterogeneity was assessed with the I² test.

Results

A total of 1,485 patients from five randomized clinical trials were included, with 737 receiving intra-articular vancomycin. The infection rate was 0.54% in the intervention group and 1.73% in the control group (RR 0,37; IC 95% 0,02-8,95; P = 0.369; I² = 49%), showing no statistically significant difference between the groups. Adverse reactions to the glycopeptide were reported in six cases (0.8%) in the intervention group compared to four cases (0.5%) in the control group (RR 1.50; 95% CI 1.50-150; p = 0.001; I² = 0%). Regarding thrombotic events, there was one case in 647 patients in the intervention group and three cases in 660 patients in the control group (RR 0.45; 95% CI 0.03-7.02; p = 0.169; I² = 0%).

Conclusion

This meta-analysis of RCTs compared the PJI rates associated with intra-articular vancomycin use in hip and knee arthroplasties. The results indicated that the use of this glycopeptide did not show a statistically significant difference compared to the control group, so that, to date, it should not be routinely indicated.