The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

Intraosseous Regional Administration of Vancomycin Prophylaxis for Primary and Revision Total Knee Arthroplasty

Document Type : In Brief

Authors
E. Carlos RODRIGUEZ-MERCHAN
Carlos A. Encinas-Ullan
Department of Orthopedic Surgery, La Paz University Hospital-IdiPaz, Madrid, Spain
10.22038/abjs.2023.71420.3337
Abstract
The advantages of prophylaxis with intraosseous regional administration (IORA) of vancomycin for periprosthetic joint infection (PJI) in primary and revision total knee arthroplasty (TKA) include the ability to deliver antibiotics directly to the surgical bed and avert systemic delivery; the ability to precisely time and quickly administer vancomycin to achieve the highest concentrations at the beginning and throughout the surgical procedure; and the ability to avert several common and potentially serious adverse effects of intravenous vancomycin. Indications for IORA of vancomycin prophylaxis include the following clinical scenarios: revision TKA; obesity; diabetes; beta-lactam allergy; known colonization with methicillin-resistant Staphylococcus aureus (MRSA); individuals coming from institutions with a high MRSA incidence; previous ligamentous surgical procedure or osteotomy; current or recent smokers; in the primary TKA setting if the individual is considered high-risk as defined by the criteria above; and during reimplantation following 2-stage exchange for PJI.
The advantages of prophylaxis with intraosseous regional administration (IORA) of vancomycin for 
periprosthetic joint infection (PJI) in primary and revision total knee arthroplasty (TKA) include the 
ability to deliver antibiotics directly to the surgical bed and avert systemic delivery; the ability to 
precisely time and quickly administer vancomycin to achieve the highest concentrations at the 
beginning and throughout the surgical procedure; and the ability to avert several common and 
potentially serious adverse effects of intravenous vancomycin. Indications for IORA of vancomycin 
prophylaxis include the following clinical scenarios: revision TKA; obesity; diabetes; beta -lactam 
allergy; known colonization with methicillin-resistant Staphylococcus aureus (MRSA); individuals 
coming from institutions with a high MRSA incidence; previous ligamentous surgical procedure or 
osteotomy; current or recent smokers; in the primary TKA setting if the individual is considered high -
risk as defined by the criteria above; and during reimplantation following 2-stage exchange for PJI. 
 Level of evidence: III
Level of evidence: III
Keywords
Intraosseous regional administration
Periprosthetic joint infection
Primary
Revision
Total knee arthroplasty
Vancomycin prophylaxis
Subjects
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The Archives of Bone and Joint Surgery
Volume 12, Issue 3
March 2024
Pages 219-222

  • Receive Date 28 March 2023
  • Revise Date 12 November 2023
  • Accept Date 13 December 2023