Because of our concern about Proprionibacterium and Coagulase negative Staph in shoulder arthroplasty, we now use IV perioperative Ceftriaxone and Vancomycin X 24 hours as our preferred antibiotic prophylaxis.
However, as these authors point out, routine use of IV Vancomycin carries with it the risk of eventual antibiotic resistance and systemic toxicity (red man syndrome, renal toxicity, otic toxicity, for example). They have explored the use of intraosseous regional administration (IORA) in arthroplasty infection prophylaxis.
They randomized 30 patients undergoing primary knee arthroplasty to receive 250 or 500 mg vancomycin via IORA or 1 g via systemic administration. IORA was performed as a bolus injection into a tibial intraosseous cannula below an inflated thigh tourniquet immediately before skin incision.
They found that the overall mean tissue concentration of vancomycin in subcutaneous fat was 14 μg/g in the 250-mg IORA group, 44 μg/g in the 500-mg IORA group, and 3.2 μg/g in the systemic group. Mean concentrations in bone were 16 μg/g in the 250-mg IORA group, 38 μg/g in the 500-mg IORA group, and 4.0 μg/g in the systemic group. One patient in the systemic group developed red man syndrome during infusion.
While these authors used preoperative infusion via a cannula inserted into the tibia before surgery, it is possible that shoulder surgeons could administer Vancomycin during impaction autografting of the medullary canal and achieve a similar effect. Topical administration may have the advantages of increased local levels of antibiotic and diminished systemic effects as well as diminished chance of inducing resistance.
**Check out the new Shoulder Arthritis Book - click here.**
To see the topics covered in this Blog, click here
Use the "Search" box to the right to find other topics of interest to you.
You may be interested in some of our most visited web pages including:shoulder arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'