TY - JOUR
T1 - Otto Aufranc Award
T2 - Intraosseous Vancomycin in Total Hip Arthroplasty — Superior Tissue Concentrations and Improved Efficiency
AU - Harper, Katharine D.
AU - Park, Kwan J.
AU - Brozovich, Ava A.
AU - Sullivan, Thomas C.
AU - Serpelloni, Stefano
AU - Taraballi, Francesca
AU - Incavo, Stephen J.
AU - Clyburn, Terry A.
N1 - Funding Information:
Publication of the Proceedings of The Hip Society in the Journal of Arthroplasty is supported by an educational grant from the American Association of Hip and Knee Surgeons.
Publisher Copyright:
© 2023
PY - 2023/7
Y1 - 2023/7
N2 - Background: Literature shows that intraosseous (IO) infusions are capable of providing increased local concentrations compared to those administered via intravenous (IV) access. Successes while using the technique for antibiotic prophylaxis administration in total knee arthroplasty (TKA) prompted consideration for use in total hip arthroplasty (THA) however; no study exists for the use of IO vancomycin in THA. Methods: This single-blinded randomized control trial was performed from December 2020 to May 2022. Twenty patients were randomized into 1 of 2 groups: IV vancomycin (15 mg/kg) given routinely, or IO vancomycin (500 mg/100cc of NS) injected into the greater trochanter during incision. Serum vancomycin levels were collected at incision and closure. Soft tissue vancomycin levels were taken from the gluteus maximus (at start and end of case), and acetabular pulvinar tissue. Bone vancomycin levels were taken from the femoral head, acetabular reamings, and intramedullary bone. Adverse local/systemic reactions, 30-day complications, and 90-day complications were also tracked. Results: A statistically significant reduction in serum vancomycin levels was seen when comparing IO to IV vancomycin at both the start and at the end of the procedure. All local tissue samples had higher concentrations of vancomycin in the IO group. Statistically significant increases were present within the acetabular bone reamings, and approached significance in intramedullary femoral bone. Conclusion: This study demonstrates the utility of IO vancomycin in primary THA with increased local tissue and decreased systemic concentrations. With positive findings in an area without tourniquet use, IO may be considered for antibiotic delivery for alternative procedures.
AB - Background: Literature shows that intraosseous (IO) infusions are capable of providing increased local concentrations compared to those administered via intravenous (IV) access. Successes while using the technique for antibiotic prophylaxis administration in total knee arthroplasty (TKA) prompted consideration for use in total hip arthroplasty (THA) however; no study exists for the use of IO vancomycin in THA. Methods: This single-blinded randomized control trial was performed from December 2020 to May 2022. Twenty patients were randomized into 1 of 2 groups: IV vancomycin (15 mg/kg) given routinely, or IO vancomycin (500 mg/100cc of NS) injected into the greater trochanter during incision. Serum vancomycin levels were collected at incision and closure. Soft tissue vancomycin levels were taken from the gluteus maximus (at start and end of case), and acetabular pulvinar tissue. Bone vancomycin levels were taken from the femoral head, acetabular reamings, and intramedullary bone. Adverse local/systemic reactions, 30-day complications, and 90-day complications were also tracked. Results: A statistically significant reduction in serum vancomycin levels was seen when comparing IO to IV vancomycin at both the start and at the end of the procedure. All local tissue samples had higher concentrations of vancomycin in the IO group. Statistically significant increases were present within the acetabular bone reamings, and approached significance in intramedullary femoral bone. Conclusion: This study demonstrates the utility of IO vancomycin in primary THA with increased local tissue and decreased systemic concentrations. With positive findings in an area without tourniquet use, IO may be considered for antibiotic delivery for alternative procedures.
KW - complications
KW - periprosthetic joint infection
KW - prevention
KW - technique
KW - total hip arthroplasty
KW - Humans
KW - Awards and Prizes
KW - Vancomycin
KW - Surgical Wound/complications
KW - Arthroplasty, Replacement, Hip/adverse effects
KW - Prosthesis-Related Infections/etiology
KW - Antibiotic Prophylaxis/methods
KW - Anti-Bacterial Agents/therapeutic use
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U2 - 10.1016/j.arth.2023.04.028
DO - 10.1016/j.arth.2023.04.028
M3 - Article
C2 - 37088221
AN - SCOPUS:85156245727
SN - 0883-5403
VL - 38
SP - S11-S15
JO - Journal of Arthroplasty
JF - Journal of Arthroplasty
IS - 7
ER -