The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

Challenges in Managing Vancomycin Flushing Syndrome Following Vancomycin-Loaded Bone Cement for Periprosthetic Joint Infection: A Case Report

Document Type : CASE REPORT

Authors
Mehdi Motififard
Mehdi Teimouri
Hossein Akbari Aghdam
Hadi Ravanbod
Mohammad Shahsavan
Department of Orthopedic Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
10.22038/abjs.2024.79046.3626
Abstract
Periprosthetic joint infection (PJI) is a critical complication following arthroplasties, often treated with 
a two-stage revision using antibiotic-loaded bone cement spacers. Although these spacers can 
effectively manage infections, they occasionally cause severe adverse reactions. We reported the case 
of a 68-year-old female who developed vancomycin flushing syndrome (VFS), previously known as the 
red man syndrome, following the insertion of a vancomycin-loaded bone cement spacer during the firststage revision surgery for PJI after undergoing total knee arthroplasty. Six hours postoperatively, she 
developed pruritus, diffuse rash, tachycardia, and hypotension. VFS was diagnosed based on clinical 
presentation after excluding other potential causes. She was treated with intravenous epinephrine, 
antihistamines, steroids, and fluid resuscitation without requiring spacer removal. The patient recovered 
uneventfully, underwent second-stage reimplantation after 6 weeks, and remained asymptomatic at 2-
year follow-up. This highlights the importance of anticipating and managing this potentially severe 
reaction through a multidisciplinary approach, considering the risks and benefits of retaining versus 
removing antibiotic-loaded bone-cement spacers.
 Level of evidence: IV
Keywords
Antibiotic cement
Periprosthetic joint infections
Total knee arthroplasty
Two-stage revision
Vancomycin
Vancomycin flushing syndrome
Subjects
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The Archives of Bone and Joint Surgery
Volume 12, Issue 9
September 2024
Pages 674-678

  • Receive Date 31 March 2024
  • Revise Date 11 June 2024
  • Accept Date 26 June 2024