Sterile Wounds Seemed Like a Good Idea

Sprinkling some vancomycin powder (vanco) in a wound seems like a reasonable idea. First adopted in total joint arthroplasty, it has gained popularity in foot and ankle. But where is the evidence and could we be unintentionally making things worse?

Vanco in wounds for total hip arthroplasty (THA) did not decrease infection

Doxey et al. analyzed 523 patients who underwent primary THA with intrawound vancomycin powder (IVP) and 670 patients with similar age, BMI, and sex who did not receive IVP during surgery. Overall, patients who received IVP had a higher rate of culture-positive prosthetic joint infections (PJI) vs. patients who did not receive IVP (1.7% vs. 0.3%). 

New recommendations THA regarding IVP

These findings suggest that the role of IVP in THA may not provide protective effects against PJI and may even be associated with deleterious effects. The authors concluded that “due to the significant association with surgical site morbidity, we currently recommend against the use of IVP in primary THA.”