Published online Jan 7, 2022. doi: 10.12998/wjcc.v10.i1.71
Peer-review started: August 10, 2021
First decision: September 2, 2021
Revised: October 21, 2021
Accepted: November 23, 2021
Article in press: November 23, 2021
Published online: January 7, 2022
Processing time: 141 Days and 23.2 Hours
Total joint arthroplasty (TJA) is highly effective for reducing pain and improving quality of life in patients requiring joint replacement. However, implant infections remain a relatively rare but devastating complication associated with this procedure. Although improved sterile techniques, wound protection, minimization of contamination, and prophylactic antibiotics (systemic or local antibiotics) have markedly reduced the incidence of surgical site infection following TJA, implants may become infected by direct contact with an infected wound during the procedure or by spread of a superficial wound infection to the fascia lata or bloodborne contamination during or after the procedure. Intraoperative contamination of the surgical wound by bacterial seeding from the air of the operating room, the skin of the patient, or fallen debris or hair from surgical staff is an important cause of surgical site infection following TJA. In addition, TJA can lead to hematoma formation, which creates conditions that encourage bacterial growth, and bacteria can form biofilms that protect them from antimicrobials and the patients’ immune response, thus making eradication difficult.
The incidence of postoperative wound infection is estimated to be 0.5%-2% following primary TJA and 3%–7% following revision TJA. Local application of an antibiotic solution may reduce the contamination of wounds with commensal bacteria from the patient’s skin or with airborne bacteria during TJA. Prior studies have demonstrated that compared with plain irrigation, lavage of the surgical wound with diluted vancomycin before closure can decrease the rate of infection following arthroscopic surgery.
Prior studies have demonstrated that compared with plain irrigation, lavage of the surgical wound with diluted vancomycin before closure can decrease the rate of infection following arthroscopic surgery.
One surgeon performed all the procedures in the given time period. Patients were identified, and data related to patient demographics, baseline characteristics, and comorbidities and operative data were collected from medical records. These cases were retrospectively reviewed for the occurrence of surgical site infections within 3 mo after surgery. Each patient received standard antibiotic prophylaxis (2 g cefazolin) approximately 30 min before surgery. Antibiotic-loaded cement was used in patients with a higher risk for infection due to a body mass index of > 35, diabetes mellitus, or rheumatoid arthritis.
There were no significant differences in sex, age, duration of surgical procedure, or use of antibiotic-loaded cement between the two groups. There was a significantly higher incidence of acute infection at the surgical site in patients who received intrawound irrigation with normal saline prior to wound closure than in patients who received intrawound irrigation with vancomycin solution prior to wound closure. The overall incidence of infection in group 1 was 2.46%, and that in group 2 was 0.09%.
Prophylactic irrigation with vancomycin solution significantly reduces the incidence of infection after primary TJA. This strategy is a safe, efficacious, and inexpensive method for reducing the incidence of surgical site infection after TJA.
Prophylactic irrigation with vancomycin solution is a safe, efficacious, and inexpensive method for reducing the incidence of surgical site infection after TJA.