Intraosseous Vancomycin for Acute Periprosthetic Knee Infection: A Retrospective Study
Abstract
Introduction: Periprosthetic joint infection (PJI) is an uncommon but serious complication after total knee arthroplasty (TKA), with significant clinical and healthcare implications. This study evaluated the effectiveness of the debridement, antibiotics, and implant retention (DAIR) protocol combined with intraosseous vancomycin administration and modular component exchange in controlling acute infection and improving functional outcomes. Materials and Methods: We conducted a retrospective study across three institutions, including 12 patients (7 women, 5 men; mean age, 72.4 ± 6.3 years) with acute PJI treated with DAIR between February 2022 and June 2023. The mean interval between primary TKA and the DAIR procedure was 12.3 days. A standardizedprotocol was applied, consisting of intraosseous vancomycin delivery, modular component exchange, and pathogen-directed antibiotic therapy. Results: The mean surgical time was 95 ± 10 minutes. Infection control was achieved in 11 of 12 cases (91.6%), with one reinfection requiring two-stage revision. The Knee Society Score improved significantly from 42.5 ± 5.8 preoperatively to 88.6 ± 6.3 at 1 year (p < 0.001). Conclusion: The DAIR protocol with intraosseous vancomycin and modular component exchange appears to be a promising strategy for managing acute periprosthetic knee infection. Larger studies are needed to confirm these preliminary results.Downloads
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