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No study has evaluated the effect of topical powdered vancomycin in patients undergoing primary total knee arthroplasty (TKA). The goal of this study is to determine if this method reduces postoperative infection rates following primary TKA.This retrospective study reviewed 855 consecutive patients undergoing TKA. The first 418 patients, who did not receive topical vancomycin, were grouped into the control group and the subsequent 437 patients, who received powdered vancomycin applied to the target joint prior to wound closure, were grouped into the treatment group.The control group was found to have 18 infectious complications (4.3%) compared with 6 (1.4%) in the treatment group, which differed significantly (p0.05). When comparing the rates of infectious complications independently, there was no significant difference in the rate of superficial infection (3.1% vs. 1.4%; p0.05), while the difference in prevalence of periprosthetic joint infection (PJI) was statistically significant (1.2% vs. 0; p0.05). No serious adverse events (AEs) occurred.Topical application of powdered vancomycin may present a reasonable means of decreasing the risk of infectious complications following TKA. There were no serious AEs associated with topical vancomycin. Further research is needed to focus on its long-term efficacy and safety.III, retrospective, cohort study.

Background No study has evaluated the effect of topical powdered vancomycin in patients undergoing primary total knee arthroplasty (TKA). The goal of this study is to determine if this method reduces postoperative infection rates following primary TKA. Patients and methods This retrospective study reviewed 855 consecutive patients undergoing TKA. The first 418 patients did not receive topical vancomycin were grouped into the control group, and the subsequent 437 patients received powdered vancomycin applied to the target joint prior to wound closure were grouped into the treatment group. Results The control group was found to have 18 infectious complications (4.3%) compared with 6 (1.4%) in the treatment group, which differed significantly (p 0.05), while the difference in prevalence of periprosthetic joint infection (PJI) was statistically significant (1.2% vs. 0; p Discussion Topical application of powdered vancomycin may present a reasonable means of decreasing the risk of infectious complications following TKA. There were no serious AEs associated with topical vancomycin. Further research is needed to focus on its long-term efficacy and safety. Level of evidence β, retrospective, cohort study.

To release extension contracture of the knee, the authors used a minimally invasive technique: percutaneous quadriceps tendon pie-crusting release. Percutaneous pie-crusting release was performed using an 18-gauge needle to puncture the stiff fibrous band of the distal and lateral quadriceps tendon under maximum knee flexion. Quadriceps contracture was gradually released by multiple needle punctures. A knee brace was prescribed for one week and knee flexion exercises were performed on the first postoperative day. This technique was performed in seven post-traumatic stiff knees and five stiff total knee arthroplasties. Mean maximum flexion increased from 37 o preoperatively to 50 o after arthrolysis and 107 o after pie-crusting. At a mean follow-up of eight months, mean maximum flexion was 103 o . There were no major complications. The technique of quadriceps tendon pie-crusting release is a simple, minimally invasive and effective treatment for knee extension contracture.