Use of regional administration of prophylactic antibiotics in total knee arthroplasty

Symonds, Tristan; Parkinson, Ben; Hazratwala, Kaushik; McEwen, Peter; Wilkinson, Matthew; Grant, Alan

doi:10.1111/ans.14816

Cited by 6 publications

(2 citation statements)

References 39 publications

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“…Two patients in the systemic group developed superficial infections, and no deep infections were recorded. Despite these promising results, as highlighted in a 2018 review, the effect of IORA on prosthetic joint infection rates remains to be seen [37].…”

Section: Intraosseous Regional Administration Of Antibioticsmentioning

confidence: 99%

Contemporary Strategies to Prevent Infection in Hip and Knee Arthroplasty

Batty

Lanting

2020

Curr Rev Musculoskelet Med

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Purpose of Review Prosthetic joint infection (PJI) remains a serious concern in lower limb arthroplasty. Despite the significant consequences of PJI, the assessment of the safety and efficacy of preventative measures is challenging due to a low event rate. Notwithstanding, enormous efforts have been made in this arena, and prevention strategies continue to evolve. This review provides an update on contemporary literature (published within the last 5 years) pertaining to infection prevention in primary hip and knee arthroplasty. Recent Findings Patient optimization has been highlighted as a critical preoperative factor in mitigating PJI risk. Recent evidence emphasizes the importance of preoperative glycaemic control, nutritional status, weight optimization and smoking cessation prior to hip and knee arthroplasty. Perioperatively, attention to detail in terms of surgical skin preparation agent and technique as well as prophylactic antibiotic agent, spectrum, dose and timing is important with statistically and clinically significant differences seen between differing strategies. Intraosseous regional antibiotic administration is an emerging technique with promising preclinical data. Dilute betadine lavage also shows promise. Data supporting bundled interventions continues to grow. Summary A multimodal approach is required in PJI prevention, and attention to detail is important with each element. Patient optimization is critical, as is the execution of the planned perioperative infection prevention strategy.

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Section: Intraosseous Regional Administration Of Antibioticsmentioning

confidence: 99%

Contemporary Strategies to Prevent Infection in Hip and Knee Arthroplasty

Batty

Lanting

2020

Curr Rev Musculoskelet Med

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“…They found that the vancomycin concentration in the IORA group was 5.3 times than that of the intravenous infusion group. Symonds et al 12 suggested that administering antibiotics via IORA during TKA might reduce the incidence of periprosthetic joint infections. These studies suggest the feasibility of using IORA to deliver TXA in TKA.…”

Section: Introductionmentioning

confidence: 99%

Impact of intraosseous regional administration of tranexamic acid in total knee arthroplasty on perioperative blood loss: a protocol for a randomised controlled trial

Wei,

Yu,

et al. 2024

BMJ Open

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IntroductionTotal knee arthroplasty (TKA) is a common surgical intervention to treat joint diseases. However, TKA is associated with significant blood loss. Tranexamic acid (TXA) has been used to reduce perioperative bleeding and postoperative blood transfusion. This study aims to explore the effectiveness and safety of intraosseous regional administration (IORA) of TXA in TKA and compare differences in perioperative blood loss between IORA of TXA, intravenous infusion of TXA, and combined IORA and intravenous infusion of TXA.Methods and analysisThis randomised controlled trial will enrol 105 patients with osteoarthritis who meet the inclusion criteria for unilateral TKA. Patients were randomly divided into three groups using the random number table method. Group A received 1.0 g of TXA via IORA, group B received 1.0 g of TXA via intravenous infusion 15 min prior to the tourniquet release, and group C received both IORA of 1.0 g of TXA and intravenous infusion of 1.0 g of TXA. The primary outcome measure is perioperative total blood loss. Secondary outcomes include bleeding events, venous thromboembolism events, inflammation reactions, other complications and knee function assessments.Ethics and disseminationThis study has been approved by the Ethics Committee of Peking Union Medical College Hospital and registered in the Chinese Clinical Trial Registry. Informed consent will be obtained from all the patients before enrolment. The trial will be conducted in accordance with the principles of the Declaration of Helsinki and the International Conference on Harmonization Good Clinical Practice guidelines. The results of this study will be disseminated through peer-reviewed publications, conference presentations and social media platforms. The findings will provide valuable insights into the use of IORA of TXA in TKA and may lead to the development of new strategies for perioperative blood management in joint replacement surgery.Trial registration numberThe Ethics Committee of Peking Union Medical College Hospital (approval number: K2371); Chinese Clinical Trial Registry (trial registration number: ChiCTR2200066293).

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Intraoperative Prevention Strategies to Prevent Infection

Vertullo¹

2021

Infection in Knee Replacement

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Use of regional administration of prophylactic antibiotics in total knee arthroplasty

Cited by 6 publications

References 39 publications

Contemporary Strategies to Prevent Infection in Hip and Knee Arthroplasty

Contemporary Strategies to Prevent Infection in Hip and Knee Arthroplasty

Impact of intraosseous regional administration of tranexamic acid in total knee arthroplasty on perioperative blood loss: a protocol for a randomised controlled trial

Intraoperative Prevention Strategies to Prevent Infection

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