CME OnDemand: 2022 AOFAS Annual Meeting-Prophylaxis for the Prevention of Prostetic Joint Infection After Total Ankle Joint Arthroplasty: Is It Ethically Justifiable?

Prophylaxis for the Prevention of Prostetic Joint Infection After Total Ankle Joint Arthroplasty: Is It Ethically Justifiable?

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Pdf Summary

This study aimed to determine the cost-effectiveness of using topically applied vancomycin powder to prevent prosthetic joint infection (PJI) following total ankle arthroplasty (TAA). The researchers conducted a break-even analysis using data from literature reviews, institutional records, and a modified equation. They found that vancomycin powder remained cost-effective for PJI prevention even at low initial PJI rates and varying costs of TAA revision. The cost of 1 gram of vancomycin powder at their institution was $3.06. If the initial PJI rate of 4% decreased by an absolute risk reduction of 0.02%, the number needed to treat (NNT) to prevent a single PJI and still break even on cost was 5,304. Varying the cost of vancomycin powder did not impact its cost-effectiveness, as it remained cost-effective when the price ranged from $2.50 to $100.00 per gram. Further analysis demonstrated that vancomycin powder was cost-effective even at an initial PJI rate as low as 0.05%. Holding the cost and initial PJI rate constant, vancomycin powder remained cost-effective for TAA revision costs ranging from $1,000 to $10,000. The researchers emphasized that their economic model could be applied by surgeons at their own institutions to assess the cost-effectiveness of vancomycin powder. However, the study had limitations such as omitting certain expenses related to PJI and not considering potential complications from vancomycin powder. Despite these limitations, the study concluded that intraoperative vancomycin powder can be highly cost-effective and should be considered for use in TAA patients.

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Brandon J Martinazzi, Gregory J Kirchner, Hannah H Nam, Kelly Dopke, Kirsten Mansfield, Anna Ptasinski, Michael C AynardiPenn State University Dept. of Orthopaedicsand Rehabilitation, Milton S. Hershey Medical Center, Hershey, PA

Keywords

cost-effectiveness

topically applied vancomycin powder

prosthetic joint infection

total ankle arthroplasty

break-even analysis

PJI prevention

initial PJI rate

cost of vancomycin powder

number needed to treat

TAA revision costs