TY - JOUR
T1 - Serum and Wound Vancomycin Levels After Intrawound Administration in Primary Total Joint Arthroplasty
AU - Johnson, Jeremiah D.
AU - Nessler, Joseph M.
AU - Horazdovsky, Ryan D.
AU - Vang, Sandy
AU - Thomas, Avis J.
AU - Marston, Scott B.
PY - 2017/3/1
Y1 - 2017/3/1
N2 - Background Periprosthetic joint infection is the most common cause of readmissions after total joint arthroplasty (TJA). Intrawound vancomycin powder (VP) has reduced infection rates in spine surgery; however, there are no data regarding VP in primary TJA. Methods Thirty-four TJA patients received 2 g of VP intraoperatively to investigate VP's pharmacokinetics. Serum and wound concentrations were measured at multiple intervals over 24 hours after closure. Results All serum concentrations were subtherapeutic (<15μg/mL) and peaked 12 hours after closure (4.7μg/mL; standard deviation [SD], 3.2). Wound concentrations were 922 μg/mL (SD, 523) 3 hours after closure and 207 μg/mL (SD, 317) at 24 hours. VP had a half-life of 7.2 hours (95% confidence interval, 7.0-9.3) in TJA wounds. Conclusions VP produced highly therapeutic intrawound concentrations while yielding low systemic levels in TJA. VP may serve as a safe adjunct in the prevention of periprosthetic joint infection.
AB - Background Periprosthetic joint infection is the most common cause of readmissions after total joint arthroplasty (TJA). Intrawound vancomycin powder (VP) has reduced infection rates in spine surgery; however, there are no data regarding VP in primary TJA. Methods Thirty-four TJA patients received 2 g of VP intraoperatively to investigate VP's pharmacokinetics. Serum and wound concentrations were measured at multiple intervals over 24 hours after closure. Results All serum concentrations were subtherapeutic (<15μg/mL) and peaked 12 hours after closure (4.7μg/mL; standard deviation [SD], 3.2). Wound concentrations were 922 μg/mL (SD, 523) 3 hours after closure and 207 μg/mL (SD, 317) at 24 hours. VP had a half-life of 7.2 hours (95% confidence interval, 7.0-9.3) in TJA wounds. Conclusions VP produced highly therapeutic intrawound concentrations while yielding low systemic levels in TJA. VP may serve as a safe adjunct in the prevention of periprosthetic joint infection.
KW - intrawound vancomycin concentration
KW - periprosthetic infection
KW - primary total joint arthroplasty
KW - prophylactic vancomycin
KW - serum vancomycin concentration
KW - topical vancomycin
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U2 - 10.1016/j.arth.2015.10.015
DO - 10.1016/j.arth.2015.10.015
M3 - Article
C2 - 27633945
AN - SCOPUS:85009178459
SN - 0883-5403
VL - 32
SP - 924
EP - 928
JO - Journal of Arthroplasty
JF - Journal of Arthroplasty
IS - 3
ER -