[Translated article] Complications of intraosseous administration of vancomycin in total hip arthroplasty

Abstract

Introduction

The incidence of periprosthetic joint infection (PJI) in hip surgeries has significantly decreased thanks to intravenous (IV) antibiotic prophylaxis. However, in patients colonised with methicillin-resistant Staphylococcus aureus (MRSA) or those at risk of colonisation, it is necessary to include vancomycin in the prophylaxis. Intraosseous administration of vancomycin could enhance its effectiveness in total hip arthroplasty (THA).

Materials and methods

A retrospective study was conducted between March and December 2023 involving 53 patients scheduled for primary THA with colonisation risk factors. The median age of the patients was 67 years (range 61–75), and all received treatment with intraosseous vancomycin (500 mg). Detailed records and documentation of complications during hospitalisation and the first three months post-surgery were maintained. As a secondary outcome measure, the incidence of PJI was explored.

Results

We administered 500 mg of intraosseous vancomycin, injected into the greater trochanter, along with standard IV prophylaxis. The incidence of complications was 1.64%. The PJI rate at 90 days was 0%.

Conclusions

Intraosseous administration of low-dose vancomycin in THA for patients at risk of MRSA colonisation, combined with standard IV prophylaxis, was shown to be safe and did not present significant adverse effects. Furthermore, this strategy eliminates the logistical challenges associated with timely vancomycin administration.

Level of evidence IV: Case series.