Higher Cefazolin Concentrations with Intraosseous Regional Prophylaxis in TKA

The Mark Coventry Award: Higher Tissue Concentrations of Vancomycin With Low-dose Intraosseous Regional Versus Systemic Prophylaxis in TKA

“…We previously validated intraosseous regional administration (IORA) of prophylactic cefazolin in TKA [41] and recorded markedly higher tissue concentrations of antibiotic than were achievable with systemic administration. IORA may allow lower vancomycin doses, thereby reducing systemic toxicity and avoiding the difficulties associated with prolonged preoperative infusion times.…”

Infection post-total knee replacement: current concepts

“…Intraosseous antibiotic infusion through a tibial cannula after tourniquet inflation and before surgical incision was proposed as an alternative route for prophylactic antibiotic administration in a small size randomized prospective study [15]. A unique advantage of this method is obtaining high concentrations of antibiotic in surgical field tissues (10-15 times higher than systemic administration) that can be particularly helpful for prophylaxis of PJI caused by bacteria with high minimally inhibitory concentrations against cephalosporins such as coagulase negative staphylococci.…”

Clinical Issues‐December 2013

“…Other authors have discussed antibiotic regimens that are based on the half‐life of the antibiotic selected and considerations for a repeat dose during long procedures, 15 the use of antimicrobial‐loaded bone cements for prophylaxis related to orthopedic implants, 16 and whether prophylactic antibiotics should be withheld to avoid inaccurate culture reports when the patient undergoes surgery because of an infected TKA 17 . Researchers also have published studies regarding regional antibiotic prophylaxis using a hand 18 or foot vein 19 on the surgical extremity or by using an intraosseous cannula placed in the medial aspect of the proximal tibia 20 to inject antibiotics after the tourniquet has been inflated.…”