Intra-Articular Vancomycin Powder in Primary Total Knee Arthroplasty: A Retrospective Observational Study.

Abstract

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. 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. 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 (<i>P</i> = .266). Aseptic wound complications were observed in 28 patients (4.2%), including 20 control patients (4.8%) and 8 vancomycin patients (3.2%) (<i>P</i> = .326). Acute kidney injury occurred in 12 patients (1.8%), with comparable rates between groups (<i>P</i> = 1.000). 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.