Concentration, Antibacterial Effect, and Safety of Combining Intra-Articular Epsilon-Aminocaproic Acid and Vancomycin in Primary Total Knee Arthroplasty: A Randomized Study.

Abstract

In this study, we aimed to investigate the intra-articular concentration, antibacterial effect, and safety of a combination of vancomycin and epsilon-aminocaproic acid (EACA) in primary total knee arthroplasty (TKA). There were 94 patients who underwent unilateral primary TKA and were randomized into the vancomycin plus EACA group and the vancomycin group. There were 47 contemporary TKAs propensity score-matched to form the EACA group. The vancomycin plus EACA group received vancomycin 30 mL (1,000 mg) plus EACA 20 mL, the vancomycin group received vancomycin plus saline, and the EACA group received saline plus EACA. Postoperative blood and drainage samples were collected for vancomycin analysis using liquid chromatography-tandem mass spectrometry. Perioperative blood loss, renal function, and bacterial tests for common periprosthetic joint infection pathogens were evaluated. Perioperative blood loss in the vancomycin plus EACA group was equivalent to that in the EACA group and significantly lower than that in the vancomycin group (P < 0.01). The intra-articular vancomycin levels in the vancomycin plus EACA group were higher than those in the vancomycin group at two, eight, and 24 hours, while the serum levels were similar. Antimicrobial effects were comparable in the vancomycin plus EACA and the vancomycin groups, both of which were superior to those in the EACA group. There were no cases of acute renal injury, ototoxicity, or anaphylaxis. The combination of intra-articular vancomycin and EACA maintained the vancomycin concentration without impairing the antifibrinolytic function of EACA, although it did not enhance the antibacterial effect of vancomycin.