Clinical efficacy of topical vancomycin powder in the prevention of surgical site infection in total joint arthroplasty: a systematic review and meta-analysis.

Objective: To evaluate the clinical efficacy of the topical application of vancomycin powder in the prevention of surgical site infection after total joint arthroplasty (TJA).

Method: Five English-language databases and four Chinese-language databases were systematically searched from the establishment of the database to 31 January 2024, and a meta-analysis was performed using Review Manager 5.3 software.

Results: A total of 34 314 patients from 17 studies were included in this meta-analysis. The results showed that, compared with the control group, the topical application of vancomycin powder in the experimental group reduced the overall incidence of prosthetic joint infection (PJI) after TJA surgery (P < .001). Within the subdivisions of the surgical field, in total knee arthroplasty, the incidence of PJI was significantly lower in the experimental group using vancomycin powder than in the control group not using this powder (P < .001). In total hip arthroplasty, the incidence of PJI was also significantly lower in the experimental group than in the control group (P = .004). However, 11 studies mentioned adverse reactions, and the results showed that the incidence of adverse reactions in the experimental group increased compared with the control group (P = .008).

Conclusion: The application of vancomycin powder appears to significantly reduce PJI risk in TJA patients; however, an increased incidence of postoperative wound complications warrants cautious clinical consideration.