Intraosseous cefuroxime achieved higher local tissue concentrations than IV injection in TKA: study

Dr Supreeth  D R

Intraosseous cefuroxime achieved higher local tissue concentrations than IV injection in TKA: study

Written By : Dr Supreeth D R Published On 2025-11-19T20:45:33+05:30 | Updated On 20 Nov 2025 12:41 PM IST

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. Te Liu et al conducted a study to evaluate the safety and efficacy of standalone intraosseous (IO) cefuroxime for TKA infection prophylaxis and determined its optimal dose. The article has been published in ‘The Journal of Arthroplasty.’

There were 30 primary TKA patients divided into three groups: IO administration of 750 mg cefuroxime (C750IO group), IO administration of 1,500 mg cefuroxime (C1500IO group), and IV administration of 1,500 mg cefuroxime (C1500IV 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 key findings of the study were:

• The C750IO and C1500IO groups showed higher tissue cefuroxime concentrations than the C1500IV group (P < 0.05). Except for the proximal tibial bone sample, there were no significant differences in cefuroxime concentrations between the C750IO and C1500IO groups (P > 0.05).

• Intraoperative blood concentrations were lower in the IO groups compared to C1500IV (P < 0.05), but post-tourniquet–release levels in C1500IO exceeded other groups.

• There were no intergroup differences in vital signs that occurred (P > 0.05).

• Postoperative inflammatory marker levels were higher in the C1500IV group than in the C750IO and C1500IO groups, with significantly lower erythrocyte sedimentation rate levels in the C750IO group on postoperative day three compared to the C1500IV group (P = 0.017).

• No infections or adverse drug events occurred within three months postoperatively.

The authors concluded – “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.”

MBBS, Dip. Ortho, DNB ortho, MNAMS

Dr Supreeth D R (MBBS, Dip. Ortho, DNB ortho, MNAMS) is a practicing orthopedician with interest in medical research and publishing articles. He completed MBBS from mysore medical college, dip ortho from Trivandrum medical college and sec. DNB from Manipal Hospital, Bengaluru. He has expirence of 7years in the field of orthopedics. He has presented scientific papers & posters in various state, national and international conferences. His interest in writing articles lead the way to join medical dialogues. He can be contacted at editorial@medicaldialogues.in.