Intraosseous Vancomycin in Total Knee Arthroplasty: A Systematic Review and Meta-Analysis.

Abstract

<h4>Background</h4>Prosthetic joint infections (PJIs) are a major concern in total knee arthroplasty (TKA). One recent measure of interest has been the use of intraosseous vancomycin (IOV). This systematic review aims to evaluate the efficacy of IOV to prevent infection in TKA.<h4>Methods</h4>A search was conducted across MEDLINE/Pubmed, Wiley Central, Google Scholar, Web of Science, and Embase databases. Demographics and results of the studies were extracted from the articles that met inclusion criteria. Meta-analysis was conducted on primary TKA studies.<h4>Results</h4>Eight studies were included in this systematic review. IOV correlated with decreased odds of infection in primary TKA (odds ratio: 0.31, <i>P</i> = .02) when compared with controls of intravenous antibiotic and no regional IOV. IOV showed no increase in AKI or creatinine concentration in primary TKA when compared with controls. IOV and increased concentration of vancomycin in fat and subcutaneous tissues had a strong correlation (Cohen's d = 0.9, <i>P</i> = .01). IOV and increased concentration of vancomycin in bone had a moderate correlation (Cohen's d = 0.59, <i>P</i> = .01). No patients where IOV was used across all studies developed Red Man Syndrome.<h4>Conclusions</h4>IOV is an effective adjunctive treatment for preventing infection in primary TKA, with this study showing a 69% decreased odds of infection when compared with controls of intravenous antibiotic and no regional IOV. IOV also appears to be a safe treatment, and with limited data there seems to not be an increase in AKI or creatinine concentration.<h4>Level of evidence</h4>Level IV; Therapeutic.