[Translated article] Vancomycin powder in the prevention of infection in primary knee and hip arthroplasty: Case-control study with 1151 arthroplasties.

BACKGROUND AND OBJECTIVE: Vancomycin powder (VP) has been positively used in spinal surgery to reduce the rate of infections. Hardly any data have been published on hip and knee joint replacement surgery, and its usefulness is questioned. Our objective was to investigate the effectiveness of VP in reducing prosthetic infection and its possible complications. METHODS: Primary hip (THA) and knee (TKA) arthroplasties were reviewed, performed by five surgeons in one hospital centre, between 2017 and 2018. One gram of VP was used on the implant prior to surgical closure based on the surgeon's preferences. With a 5-year follow-up in which the infection rate and local complications were analysed. RESULTS: One thousand one hundred and fifty-one arthroplasties were performed, 748 were TKA and 403 were THA. Nine patients were diagnosed with prosthetic infection, of which five received VP and four did not (p=0.555). Likewise, another 15 patients suffered wound complications, of which 11 received VP and 4 did not (p=0.412). There were no differences, either, in the rest of the complications depending on the use or not of VP (p=0.101). Likewise, the number of patients who needed reintervention was similar (p=0.999). No systemic complications were detected due to the use of VP. CONCLUSIONS: It has not been possible to demonstrate that the use of VP reduces the rates of prosthetic infection in the hip and knee, so we cannot recommend its use.

Vancomycin powder in the prevention of infection in primary knee and hip arthroplasty: Case-control study with 1151 arthroplasties. / Vancomicina en polvo en la prevención de la infección en artroplastia primaria de rodilla y cadera: estudio de casos y controles con 1.151 artroplastias.

BACKGROUND AND OBJECTIVE: Vancomycin powder (VP) has been positively used in spinal surgery to reduce the rate of infections. Hardly any data have been published on hip and knee joint replacement surgery, and its usefulness is questioned. Our objective was to investigate the effectiveness of VP in reducing prosthetic infection and its possible complications. METHODS: Primary hip (THA) and knee (TKA) arthroplasties were reviewed, performed by five surgeons in one hospital center, between 2017 and 2018. 1g of VP was used on the implant prior to surgical closure based on the surgeon's preferences. With a 5-year follow-up in which the infection rate and local complications were analyzed. RESULTS: One thousand one hundred and fifty one arthroplasties were performed, 748 were TKA and 403 were THA. Nine patients were diagnosed with prosthetic infection, of which five received VP and four did not (P=.555). Likewise, another 15 patients suffered wound complications, of which 11 received VP and 4 did not (P=.412). There were no differences, either, in the rest of the complications depending on the use or not of VP (P=.101). Likewise, the number of patients who needed reintervention was similar (P=.999). No systemic complications were detected due to the use of VP. CONCLUSIONS: It has not been possible to demonstrate that the use of VP reduces the rates of prosthetic infection in the hip and knee, so we cannot recommend its use.

Total knee arthroplasty for treatment of osteoarthritis associated with extra-articular deformity.

OBJECTIVE: Our purpose was to review senior author results of TKA in patients with extra-articular angular deformities (correction of mechanical axis was performed without an additional procedure for osteotomy). METHODS: Results of TKA in nine knees with osteoarthritis and associated extra-articular angular deformity of femur were reviewed retrospectively. This group was compare with a with a control group of 20 patients diagnosed with osteoarthritis that underwent TKA without extra-articular deformity. Angulation of deformity in patients was 19° in coronal plane (range 15°-25°) and 12° in sagittal plane (range 8°-5°). Knee Score (KS) and Functional Score (FS) were measured pre and post-surgery, likewise arc flexion was reported. Results in KS and FS were correlationed with extra-articular angulation. RESULTS: Duration of follow-up averaged 55 months (range, 48-63 months). KS Average and FS increased from 50.5 and 38.4 points, preoperatively, to 96.5 and 84.4 points, respectively, at time of following-up. No statistically significant differences in any postoperative parameters were found between the postoperative group of extra-articular deformities and the control group were found. Positive correlation was obtained between deformity degrees and KS. Arc of motion averaged 86° preoperatively and 118° at time of following-up. No total knee arthroplasty was revised. CONCLUSION: In our opinion, best management for extra-articular deformities associated to osteoarthritis is to carry out a knee replacement without corrective osteotomy on condition that planification allow to us avoid ligaments insertions, using an extensive soft-tissue balancing in conjunction with a minimally constrained TKA.

[Effect of removing the ischaemia tourniquet on the transfusion needs of the patient undergoing primary knee arthroplasty]. / Efecto de la retirada del manguito de isquemia sobre las necesidades transfusionales en el paciente intervenido de artroplastia primaria de rodilla.

OBJECTIVE: To determine the influence of the timing of the removal of the ischaemia tourniquet on the transfusion needs in primary knee arthroplasty and its influence on post-operative complications. MATERIAL AND METHOD: A retrospective analysis was performed on 201 primary knee arthroplasties. The patients were divided into 2 groups: group A (101 patients), where the tourniquet was removed before surgical closure, and group B (100 patients), where the tourniquet was removed after the surgical closure. A comparison was made of the blood transfusions (pools of red corpuscles) received by both groups, along with the surgical time, and the post-operative complications. RESULTS: The mean number of packed red cells transfused in group A was 0.62, while in the group B it was 0.61 (P=.831). The mean time in the surgery in group A was 111 min, and in group B it was 98 min (P<.05), with no significant difference between the surgical time and the number of packed cells transfused (P=.055). The post-operative complications in the group A were 8, and in the B were 10 (P=.79). DISCUSSION: There were no differences between removing the tourniquet before or after surgical closure or in the transfusion needs or in the post-operative complications. Traditionally, the greater blood loss due to the removal of the tourniquet before surgical closure has been explained as due to the longer surgery time required. However, in the present study, this fact was not associated with greater transfusion needs, or with more post-operative complications.