Abstract：
BACKGROUND: Periprosthetic joint infection (PJI) following total joint arthroplasty (TJA) is a serious complication for patients. Some joint surgeons have tried to use vancomycin powder (VP) in total knee and total hip arthroplasty to prevent postoperative PJI, but its effect is still not clear. At present, there is no meta-analysis that specifically analyses the effect of different doses of vancomycin powder on the incidence of PJI.
METHODS: We carried out a search based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and identified the studies we needed. Review Manager (RevMan) 5.3 software was employed for statistical analysis.
RESULTS: The analysis of primary TKA (PTKA) showed that using 1 g (RR 0.38, 95% CI 0.22-0.67 [P = 0.0008]) and 2 g (RR 0.48, 95% CI 0.31-0.74 [P = 0.0008]) of vancomycin powder in primary TKA (PTKA) could all significantly prevent PJI. The analysis of primary THA (PTHA) showed that using 1 g (RR 0.37, 95% CI 0.17-0.80 [P = 0.01]) of vancomycin powder effectively decreased the incidence of PJI, while using 2 g (RR 1.02, 95% CI 0.53-1.97 [P = 0.94]) of vancomycin powder had no significant effect on preventing PJI. Because the data were abnormal, we believed the conclusion that using 2 g of vancomycin powder in primary THA had no effect on preventing PJI was doubtful. Using vancomycin powder in revision TKA (RTKA) significantly reduced the PJI rate (RR 0.33, 95% CI 0.14-0.77 [P = 0.01]), similar to revision THA (RTHA) (RR 0.37, 95% CI 0.14-0.96 [P = 0.04]).
CONCLUSIONS: In primary TKA, both 1 g and 2 g of vancomycin powder can effectively prevent PJI. In primary THA, using 1 g of vancomycin powder is a better choice, while the effect of using 2 g of vancomycin powder is not clear, and a more prospective randomized controlled trial should be done to verify it. In revision TKA and revision THA, vancomycin powder is a good choice to prevent PJI.
METHODS: We carried out a search based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and identified the studies we needed. Review Manager (RevMan) 5.3 software was employed for statistical analysis.
RESULTS: The analysis of primary TKA (PTKA) showed that using 1 g (RR 0.38, 95% CI 0.22-0.67 [P = 0.0008]) and 2 g (RR 0.48, 95% CI 0.31-0.74 [P = 0.0008]) of vancomycin powder in primary TKA (PTKA) could all significantly prevent PJI. The analysis of primary THA (PTHA) showed that using 1 g (RR 0.37, 95% CI 0.17-0.80 [P = 0.01]) of vancomycin powder effectively decreased the incidence of PJI, while using 2 g (RR 1.02, 95% CI 0.53-1.97 [P = 0.94]) of vancomycin powder had no significant effect on preventing PJI. Because the data were abnormal, we believed the conclusion that using 2 g of vancomycin powder in primary THA had no effect on preventing PJI was doubtful. Using vancomycin powder in revision TKA (RTKA) significantly reduced the PJI rate (RR 0.33, 95% CI 0.14-0.77 [P = 0.01]), similar to revision THA (RTHA) (RR 0.37, 95% CI 0.14-0.96 [P = 0.04]).
CONCLUSIONS: In primary TKA, both 1 g and 2 g of vancomycin powder can effectively prevent PJI. In primary THA, using 1 g of vancomycin powder is a better choice, while the effect of using 2 g of vancomycin powder is not clear, and a more prospective randomized controlled trial should be done to verify it. In revision TKA and revision THA, vancomycin powder is a good choice to prevent PJI.
摘要：
背景：全关节置换术（TJA）后假体周围感染（PJI）是患者的严重并发症。一些关节外科医师尝试在全膝关节和全髋关节置换术中使用万古霉素粉（VP）来预防术后PJI，但其效果仍不清楚。目前,没有荟萃分析专门分析不同剂量万古霉素粉对PJI发病率的影响.
方法：我们根据系统评价和荟萃分析（PRISMA）指南的首选报告项目进行了搜索，并确定了我们需要的研究。采用ReviewManager(RevMan)5.3软件进行统计分析。
结果：对原发性TKA（PTKA）的分析表明，在原发性TKA（PTKA）中使用1g（RR0.38，95％CI0.22-0.67[P=0.0008]）和2g（RR0.48，95％CI0.31-0.74[P=0.0008]）万古霉素粉都可以显着预防PJI。原发性THA（PTHA）分析表明，使用1g（RR0.37，95％CI0.17-0.80[P=0.01]）万古霉素粉末有效降低了PJI的发生率，而使用2g（RR1.02，95％CI0.53-1.97[P=0.94]）万古霉素粉剂对预防PJI无明显作用。因为数据异常，我们认为,在原发性THA中使用2g万古霉素粉末对预防PJI没有效果的结论值得怀疑.在修订TKA（RTKA）中使用万古霉素粉末显着降低了PJI率（RR0.33，95％CI0.14-0.77[P=0.01]），与修订THA（RTHA）相似（RR0.37，95%CI0.14-0.96[P=0.04]）。
结论：在初级TKA中，1g和2g万古霉素粉均可有效预防PJI。在初级THA中，使用1克万古霉素粉是更好的选择，虽然使用2克万古霉素粉末的效果尚不清楚，并且应该进行更前瞻性的随机对照试验来验证。在修订TKA和修订THA中，万古霉素粉是预防PJI的好选择。
方法：我们根据系统评价和荟萃分析（PRISMA）指南的首选报告项目进行了搜索，并确定了我们需要的研究。采用ReviewManager(RevMan)5.3软件进行统计分析。
结果：对原发性TKA（PTKA）的分析表明，在原发性TKA（PTKA）中使用1g（RR0.38，95％CI0.22-0.67[P=0.0008]）和2g（RR0.48，95％CI0.31-0.74[P=0.0008]）万古霉素粉都可以显着预防PJI。原发性THA（PTHA）分析表明，使用1g（RR0.37，95％CI0.17-0.80[P=0.01]）万古霉素粉末有效降低了PJI的发生率，而使用2g（RR1.02，95％CI0.53-1.97[P=0.94]）万古霉素粉剂对预防PJI无明显作用。因为数据异常，我们认为,在原发性THA中使用2g万古霉素粉末对预防PJI没有效果的结论值得怀疑.在修订TKA（RTKA）中使用万古霉素粉末显着降低了PJI率（RR0.33，95％CI0.14-0.77[P=0.01]），与修订THA（RTHA）相似（RR0.37，95%CI0.14-0.96[P=0.04]）。
结论：在初级TKA中，1g和2g万古霉素粉均可有效预防PJI。在初级THA中，使用1克万古霉素粉是更好的选择，虽然使用2克万古霉素粉末的效果尚不清楚，并且应该进行更前瞻性的随机对照试验来验证。在修订TKA和修订THA中，万古霉素粉是预防PJI的好选择。
