OBJECTIVE  To systematically evaluate the efficacy and safety of intrawound vancomycin powder for preventing surgical site infections in total knee and total hip arthroplasty.

METHODS  Computer retrieval of PubMed, Embase, Web of Science, the Cochrane Library, CNKI, Wanfang Database, Chinese Biomedical Literature Database, The clinical research about intrawound vancomycin in total knee arthroplasty(TKA) and total hip arthroplasty(THA) for the prevention of surgical site infections were screened. The quality of included studies was assessed using the Cochrane risk bias assessment tool and the Newcastle-Ottawa Scale. Meta-analysis was performed using RevMan 5.4 software.

RESULTS  Finally, 20 literature were included, including 1 prospective randomized controlled trial, 2 prospective cohort study, and 17 retrospective cohort study, with a total of 34900 patients. Meta-analysis showed that interventional group had a decreased tolal rate of prosthetic joint infection(PJI)OR=0.44, 95%CI(0.35−0.56), P<0.000 01 and superficial infectionOR=0.27, 95%CI(0.19−0.41), P<0.000 01compared with control group. Subgroup analysis showed that TKA and THA, primary and revision patients who received intrawound vancomycin had lower rates of PJI, the differences were statistical significance(P<0.05). Meta-analysis of 11 studies reported adverse reaction suggested that the total rate of adverse reactions in the intervention group(7.68%) was higher than that in the control group(5.68%) with significant differencesOR=1.47, 95%CI(1.14−1.89), P=0.003).

CONCLUSION  The current literature suggests that intrawound vancomycin can decrease the rate of PJI and superficial infection in primary and revision TKA and THA , however, it may increase risk of aseptic wound complications and other adverse reaction.