Intrawound vancomycin powder in orthopaedic surgery after the VPIP trial: a critical reappraisal of efficacy, dosing, application plane, and antimicrobial stewardship

Werneburg, Felix; Zeh, Alexander; Gutteck, Natalia; Delank, Karl-Stefan

doi:10.5194/jbji-11-343-2026

Articles | Volume 11, issue 3

https://doi.org/10.5194/jbji-11-343-2026

© Author(s) 2026. This work is distributed under
the Creative Commons Attribution 4.0 License.

https://doi.org/10.5194/jbji-11-343-2026

© Author(s) 2026. This work is distributed under
the Creative Commons Attribution 4.0 License.

Articles | Volume 11, issue 3

Review

|

12 Jun 2026

Review |

| 12 Jun 2026

Intrawound vancomycin powder in orthopaedic surgery after the VPIP trial: a critical reappraisal of efficacy, dosing, application plane, and antimicrobial stewardship

Felix Werneburg, Alexander Zeh, Natalia Gutteck, and Karl-Stefan Delank

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Short summary

For over a decade, orthopaedic surgeons have sprinkled vancomycin powder into surgical wounds to prevent infection. New large randomised trials show this is ineffective in hip and knee replacements, though possibly useful in high-risk fracture surgery and infected revision cases. Based on these findings and international guidelines, we propose a framework that identifies specifically in which operations this antibiotic powder may still have a role and in which it should be avoided.