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

Document Type : In Brief

Authors

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

Main Subjects

References

  1. Chin SJ, Moore GA, Zhang M, Clarke HD, Spangehl MJ, Young SW. The AAHKS clinical research award: intraosseous regional prophylaxis provides higher tissue concentrations in high BMI patients in total knee arthroplasty: a randomized trial. J Arthroplasty. 2018; 33(7S):S13-S18. doi: 10.1016/j.arth.2018.03.013.
  2. Harper KD, Lambert BS, O'Dowd J, Sullivan T, Incavo SJ. Clinical outcome evaluation of intraosseous vancomycin in total knee arthroplasty. Arthroplast Today. 2020; 6(2):220-223. doi: 10.1016/j.artd.2020.02.001.
  3. Arthur JR, Bingham JS, Clarke HD, Spangehl MJ, Young SW. Intraosseous regional administration of antibiotic prophylaxis in total knee arthroplasty. JBJS Essent Surg Tech. 2020; 10(4):e20.00001. doi: 10.2106/JBJS.ST.20.00001.
  4. Klasan A, Patel CK, Young SW. Intraosseous regional administration of vancomycin in primary total knee arthroplasty does not increase the risk of vancomycin-associated complications. J Arthroplasty. 2021; 36(5):1633-1637. doi: 10.1016/j.arth.2020.12.034.
  5. Park KJ, Chapleau J, Sullivan TC, Clyburn TA, Incavo SJ. 2021 Chitranjan S. Ranawat Award: Intraosseous vancomycin reduces periprosthetic joint infection in primary total knee arthroplasty at 90-day follow-up. Bone Joint J. 2021; 103-B (6 Suppl A):13-17. doi: 10.1302/0301-620X.103B6.BJJ-2020-2401.R1.
  6. Parkinson B, McEwen P, Wilkinson M, et al. Intraosseous regional prophylactic antibiotics decrease the risk of prosthetic joint infection in primary TKA: a multicenter study. Clin Orthop Relat Res. 2021; 479(11):2504-2512. doi: 10.1097/CORR.0000000000001919.
  7. Spangehl MJ, Clarke HD, Moore GA, Zhang M, Probst NE, Young SW. Higher tissue concentrations of vancomycin achieved with low-dose intraosseous injection versus intravenous despite limited tourniquet duration in primary total knee arthroplasty: a randomized trial. J Arthroplasty. 2022; 37(5):857-863. doi: 10.1016/j.arth.2022.01.057.
  8. Young SW, Zhang M, Moore GA, Pitto RP, Clarke HD, Spangehl MJ. The John N. Insall award: higher tissue concentrations of vancomycin achieved with intraosseous regional prophylaxis in revision TKA: a randomized controlled trial. Clin Orthop Relat Res. 2018; 476(1):66-74. doi: 10.1007/s11999.0000000000000013.
  9. Lachiewicz PF. Intraosseous vancomycin may not be helpful in aseptic revision knee arthroplasty: a single-surgeon consecutive case series. J Arthroplasty. 2023; 38(6S):S281-S283. doi: 10.1016/j.arth.2023.01.043.
  10. Wells Z, Zhu M, Young SW. Intraosseous regional administration of prophylactic antibiotics in total knee arthroplasty. Antibiotics (Basel). 2022; 11(5):634. doi: 10.3390/antibiotics11050634.
  11. Miltenberg B, Ludwick L, Masood R, et al. Intraosseous regional administration of antibiotic prophylaxis for total knee arthroplasty: a systematic review. J Arthroplasty. 2023; 38(4):769-774. doi: 10.1016/j.arth.2022.10.023.

 

 

The Archives of Bone and Joint Surgery
Volume 12, Issue 3
March 2024
Pages 219-222

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History

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

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