Articles | Volume 11, issue 3
https://doi.org/10.5194/jbji-11-343-2026
https://doi.org/10.5194/jbji-11-343-2026
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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Renal safety of intraoperative local vancomycin powder application in orthopedic surgery: a retrospective analysis
Juliane Beschauner, Maria Felsberg, Alexander Zeh, Karl-Stefan Delank, Natalia Gutteck, and Felix Werneburg
J. Bone Joint Infect., 10, 609–615, https://doi.org/10.5194/jbji-10-609-2025,https://doi.org/10.5194/jbji-10-609-2025, 2025
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Cited articles

Beschauner, J., Felsberg, M., Zeh, A., Delank, K.-S., Gutteck, N., and Werneburg, F.: Renal safety of intraoperative local vancomycin powder application in orthopedic surgery: a retrospective analysis, J. Bone Joint Infect., 10, 609–615, https://doi.org/10.5194/jbji-10-609-2025, 2025. 
Brothers, K. M., Parker, D. M., Taguchi, M., Ma, D., Mandell, J. B., Thurlow, L. L., Byrapogu, V. C., and Urish, K. L.: Dose optimization in surgical prophylaxis: sub-inhibitory dosing of vancomycin increases rates of biofilm formation and the rates of surgical site infection, Sci. Rep., 13, 4593, https://doi.org/10.1038/s41598-023-30951-y, 2023. 
Caroom, C., Tullar, J. M., Benton Jr., E. G., Jones, J. R., and Chaput, C. D.: Intrawound vancomycin powder reduces surgical site infections in posterior cervical fusion, Spine, 38, 1183–1187, https://doi.org/10.1097/BRS.0b013e31828fcfb5, 2013. 
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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.
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