Preoperative Stand-Alone Intraosseous Cefuroxime in Total Knee Arthroplasty: A Randomized Trial Demonstrating Superior Tissue Concentrations and Improved Efficiency.

Abstract

Intraosseous regional administration (IORA) of vancomycin for preventing infection in total knee arthroplasty (TKA) achieves high local tissue concentrations and enhances efficacy when combined with intravenous (IV) cephalosporins. This study evaluated the safety and efficacy of standalone intraosseous (IO) cefuroxime for TKA infection prophylaxis and determined its optimal dose. There were 30 primary TKA patients divided into three groups: IO administration of 750 mg cefuroxime (C750_IO group), IO administration of 1,500 mg cefuroxime (C1500_IO group), and IV administration of 1,500 mg cefuroxime (C1500_IV group). All groups received no other IV antibiotics preoperatively. During surgery, nine tissue samples were collected: bone samples were collected from the femur or tibia, synovial and fat samples were collected from the surgical area, and systemic blood samples were collected twice to detect cefuroxime levels. Intraoperative vital signs, inflammatory markers, and liver/kidney function on days one and three, and postoperative and complications within three months were recorded. The C750_IO and C1500_IO groups showed higher tissue cefuroxime concentrations than the C1500_IV group (P < 0.05). Except for the proximal tibial bone sample, there were no significant differences in cefuroxime concentrations between the C750_IO and C1500_IO groups (P > 0.05). Intraoperative blood concentrations were lower in the IO groups compared to C1500_IV (P < 0.05), but post-tourniquet-release levels in C1500_IO exceeded other groups. There were no intergroup differences in vital signs that occurred (P > 0.05). Postoperative inflammatory marker levels were higher in the C1500_IV group than in the C750_IO and C1500_IO groups, with significantly lower erythrocyte sedimentation rate levels in the C750_IO group on postoperative day three compared to the C1500_IV group (P = 0.017). No infections or adverse drug events occurred within three months postoperatively. Intraosseous cefuroxime (750 or 1500 mg) achieved higher local tissue concentrations than IV 1,500 mg in TKA. Preoperative IO 750 mg cefuroxime alone minimized systemic exposure while maintaining effective concentrations, suggesting its safety and potential as a preferred prophylactic strategy.