Intra-Articular Vancomycin Powder in Primary Total Knee Arthroplasty: A Retrospective Observational Study
Kemal Şibar, Vedat Biçici, Ezgi Gizem Şibar, Yasin Erdoğan, Erkan Akgün, Hanife Uzar, Ahmet FiratBackground:
Periprosthetic joint infection (PJI) is one of the most serious complications following total knee arthroplasty (TKA). Vancomycin powder has been proposed as a low-cost adjunct to reduce infection by providing high local antibiotic concentrations with minimal systemic exposure; however, clinical evidence remains inconsistent. This study aimed to evaluate the effect of intra-articular vancomycin powder on PJI, aseptic wound complications, and renal function in primary TKA.
Materials and Methods:
Patients who underwent primary TKA between 2022 and 2024 with at least 1 year of follow-up were retrospectively analyzed. A total of 661 patients were included: 247 received 1 g intra-articular vancomycin powder and 414 served as controls. All procedures were performed with standardized perioperative protocols. Demographics, comorbidities, and high-risk status were recorded. Outcomes included PJI, aseptic wound complications, and acute kidney injury.
Results:
PJI occurred in 7 patients (1.1%): 6 in the control group (1.4%) and 1 in the vancomycin group (0.4%), with no significant difference (
Conclusion:
Intra-articular vancomycin powder did not result in a statistically significant reduction in PJI rates, while demonstrating a favorable safety profile. Although safe, routine use may not provide additional measurable benefit in optimized surgical settings with low baseline infection rates. Larger, well-designed randomized trials are required to identify patient subgroups who may benefit from selective application.