Evidence map›Paper›PMID 22773397›Full record

Trial reportClinical orthopaedics and related research2013

Higher cefazolin concentrations with intraosseous regional prophylaxis in TKA.

Simon W Young, Mei Zhang, Joshua T Freeman, Kelly G Vince, Brendan Coleman

4 registry-linked trialsOpen access · greenAbstract readComparative StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Clinical orthopaedics and related research, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 4 registered trials, which are not on this map. Cited by 29 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
29citing papers in PubMed, 5 pooled it
2.6field-weighted citation impact, top 11% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03713528 phase4enrolling by invitationnot on this mapstarted 2020, after this paper: background citation

Can Intraosseous Antibiotics Improve the Results of Irrigation & Debridement and Prosthetic Retention for PJI?

TypeinterventionalSponsorOrthoCarolina Research Institute, Inc.Ran2020 to 2027Enrolled100ConditionsJoint InfectionArmsIntraoperative Intraosseous Vancomycin
NCT05604157 naunknown statusnot on this mapstarted 2021, after this paper: background citation

Effect of Tourniquet on Local Tissue Concentrations of Cefazolin During Total Knee Arthroplasty: A Randomized Controlled Trial

TypeinterventionalSponsorMcGill University Health Centre/Research Institute of the McGill University Health CentreRan2021 to 2025Enrolled50ConditionsInfections Joint ProstheticArmsUse of Tourniquet
NCT06640491 phase1 / phase2recruitingnot on this mapstarted 2025, after this paper: background citation

Intraosseous Vancomycin and Cefazolin vs Intravenous Administration in Primary Total Knee Arthroplasty

TypeinterventionalSponsorThe Methodist Hospital Research InstituteRan2025 to 2035Enrolled40ConditionsTotal Knee ArthroplastyArmsIO Administration of Cefazolin, IO Administration of Vancomycin, IV Administration of Cefazolin, IV Administration of Vancomycin
NCT07549542 phase4enrolling by invitationnot on this mapstarted 2025, after this paper: background citation

Efficacy and Safety of Intraosseous Antibiotic Prophylaxis in Total Hip Replacement: A Prospective Randomized Controlled Trial

TypeinterventionalSponsorRutgers, The State University of New JerseyRan2025 to 2026Enrolled25ConditionsAntibiotic Prophylaxis SurgeryArmsCeFAZolin 1000 MG, Saline (0.9%, sterile, for infusion)
3 · Its place in the literature

Who cites it

29 citing papers in PubMed, 5 syntheses or guidelines pooled it, 56 citations in OpenAlex.

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  15. Periprosthetic joint infections: state-of-the-art.Archives of orthopaedic and trauma surgery · 2024
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors at 4 institutions in 1 country.

Simon W YoungDepartment of Orthopaedics, Middlemore Hospital, Private Bag 93311, Otahuhu, Auckland 1640, New Zealand. simonwyoung@gmail.com
Mei Zhang
Joshua T Freeman
Kelly G Vince
Brendan Coleman
Middlemore Hospital · NZAuckland City Hospital · NZNorthland District Health Board · NZUniversity of Otago · NZ

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundProphylactic antibiotics reduce the risk of deep infection after primary TKA. However, conventional systemic dosing may not provide adequate tissue concentrations against more resistant organisms such as coagulase-negative staphylococci. Regional intravenous administration of antibiotics after tourniquet inflation achieves far higher tissue concentrations but requires foot vein cannulation. The intraosseous route may offer a rapid and reliable method of regional administration. QUESTIONS/PURPOSES: We compared tissue concentrations of cefazolin achieved with systemic versus regional intraosseous administration.

methodsTwenty-two patients undergoing primary TKA were randomized into two groups. Group 1 received 1 g cefazolin systemically 10 minutes before tourniquet inflation. Group 2 received 1 g cefazolin intraosseously in 200 mL of normal saline through a tibial cannula after tourniquet inflation and before skin incision. Subcutaneous fat and femoral bone samples were taken at set intervals during the procedure and antibiotic concentrations measured using a validated technique involving high-performance liquid chromatography.

resultsThe overall mean tissue concentration of cefazolin in subcutaneous fat was 186 ug/g in the intraosseous group and 11 ug/g in the systemic group. The mean tissue concentration in bone was 130 ug/g in the intraosseous group and 11 ug/g in the systemic group. These differences were consistent across all sample time points throughout the procedure.

conclusionsIntraosseous regional administration can achieve concentrations of antibiotic in tissue an order of magnitude higher than systemic administration. Further work is required to determine if this translates into increased efficacy in preventing infection, particularly against coagulase-negative staphylococci.

Indexed as

AgedAged, 80 and overAnti-Bacterial AgentsAntibiotic ProphylaxisArthroplasty, Replacement, KneeCefazolinFemaleHumansInfusions, IntraosseousInfusions, IntravenousMaleMiddle AgedSurgical Wound InfectionTreatment OutcomeAnti-Bacterial AgentsCefazolin

Identifiers

PMID22773397
PMCPMC3528899
OpenAlexW2048410185

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.