Intraosseous vancomycin results in lower superficial and deep infection rate compared with alternative intravenous

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Fardis Vosoughi1, Diako Seyedi2, Parnian Rahnama2

  • 1Department of Orthopaedics and Trauma Surgery, Shariati Hospital, Tehran University Of Medical Sciences, Tehran, Iran.

The Knee
|April 26, 2026
PubMed
Abstract

Insights

Intraosseous (IO) vancomycin prophylaxis in total knee arthroplasty (TKA) significantly lowers periprosthetic joint infection (PJI) and wound complication rates. This method achieves higher local antibiotic levels without increasing risks of kidney injury, blood clots, or revision surgery.

Area of Science:

  • Orthopedic Surgery
  • Infectious Disease
  • Pharmacology

Background:

  • Periprosthetic joint infection (PJI) is a significant complication following total joint arthroplasty (TJA).
  • Concerns regarding antimicrobial resistance to intravenous (IV) vancomycin have prompted investigation into alternative prophylaxis methods.
  • Intraosseous (IO) vancomycin is being explored as a potentially more effective prophylactic agent in TJA.

Purpose of the Study:

  • To compare the efficacy and safety of intraosseous (IO) vancomycin versus intravenous (IV) prophylaxis in total joint arthroplasty (TJA).
  • To evaluate outcomes including periprosthetic joint infection (PJI), organism-specific infections, wound complications, revision rates, pharmacokinetics, acute kidney injury (AKI), and deep vein thrombosis (DVT).

Main Methods:

  • A systematic review and meta-analysis of clinical studies involving adults undergoing total knee arthroplasty (TKA) or total hip arthroplasty (THA).
  • Studies compared IO vancomycin with alternative IV prophylaxis methods.
  • Outcomes were analyzed using random-effects models and stratified by follow-up intervals (30 days, 90 days, 1 year).

Main Results:

  • Intraosseous vancomycin resulted in significantly higher vancomycin concentrations in bone and fat tissue compared to IV administration.
  • IO vancomycin significantly reduced overall PJI and Gram-positive infections in primary TKA cases.
  • Non-operative wound complications were significantly lower with IO vancomycin, while rates of reoperation-requiring complications, AKI, DVT, and revision were comparable between groups.

Conclusions:

  • Intraosseous vancomycin prophylaxis demonstrates superior local antibiotic concentrations compared to IV administration.
  • IO vancomycin significantly reduces the incidence of PJI and superficial wound complications in primary TKA.
  • This method does not elevate the risk of renal complications, thrombotic events, or revision surgery.
Keywords:
Intraosseous vancomycinIntravenous antibiotic prophylaxisPeriprosthetic joint infectionTotal knee arthroplasty

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