Topical vancomycin powder does not affect patella cartilage degeneration in primary total knee arthroplasty and conversion rate for secondary patella resurfacing

Benjamin Jacob; Georgi Wassilew; Rüdiger von Eisenhart-Rothe; Steffen Brodt; Georg Matziolis

doi:10.1007/s00402-022-04721-w

Topical vancomycin powder does not affect patella cartilage degeneration in primary total knee arthroplasty and conversion rate for secondary patella resurfacing

Arch Orthop Trauma Surg. 2023 Aug;143(8):5249-5254. doi: 10.1007/s00402-022-04721-w. Epub 2022 Dec 20.

Authors

Benjamin Jacob¹, Georgi Wassilew², Rüdiger von Eisenhart-Rothe³, Steffen Brodt⁴, Georg Matziolis⁴

Affiliations

¹ Orthopaedic Department Waldkliniken Eisenberg, University Hospital Jena, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany. b.jacob@waldkliniken-eisenberg.de.
² Department of Orthopaedic Surgery, University Hospital Greifswald, Greifswald, Germany.
³ Department of Orthopaedics and Sports Orthopaedics, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
⁴ Orthopaedic Department Waldkliniken Eisenberg, University Hospital Jena, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany.

Abstract

Introduction: Vancomycin powder (VP) is an antibiotic first introduced in pediatric spinal surgery to prevent surgical site infections (SSI). Recently its topical application was expanded to total hip and knee arthroplasty (THA, TKA) and anterior cruciate ligament reconstruction (ACLR). Toxicity to cartilage is the subject of current research. The aim of this study was to prove the hypothesis that topical application of VP in TKA does not result in a degeneration of patella cartilage. We propagate that the conversion rate for secondary patella resurfacing is not influenced by its use.

Materials and methods: Between 2014 and 2021, 4292 joints were included in this monocentric retrospective cohort study. All patients underwent TKA without primary patella resurfacing. After a change of the procedure in the hospital, one group (VPG) was administered VP intraoperatively. The other group (nVPG) received no VP during surgery (nVPG). The remaining perioperative procedure was constant over the investigation period. Conversion rates for secondary patella resurfacing for both groups were determined without making distinctions in the indication. A second cohort was composed of patients presenting for follow-up examination 12 months after TKA and included 210 joints. Retrospective radiographic evaluations were performed preoperatively, before discharge and at follow-up examination. Patella axial radiographs were analyzed for patella tracking (lateral patellar tilt, patellar displacement) and patella degeneration (Sperner classification, patellofemoral joint space).

Results: There was no significant difference in the conversion rate for secondary patella resurfacing (4.24% VPG, 4.97% nVPG). Patella tracking and patella degeneration did not differ significantly between both groups.

Conclusions: The topical application of VP does not influence the conversion rate for secondary patella resurfacing. Moreover, it does not result in a degeneration of patella cartilage in TK.

Level of evidence: Retrospective case series, Level III.

Keywords: Cartilage; PJI; Patella resurfacing; SSI; TKA; Toxicity; Vancomycin.

MeSH terms

Arthroplasty, Replacement, Knee* / methods
Child
Humans
Knee Joint / surgery
Knee Prosthesis*
Osteoarthritis, Knee* / surgery
Patella / surgery
Powders
Retrospective Studies
Treatment Outcome
Vancomycin

Substances

Vancomycin
Powders