Evidence map›Paper›PMID 23666589›Full record

Trial reportClinical orthopaedics and related research2014

The Mark Coventry Award: Higher tissue concentrations of vancomycin with low-dose intraosseous regional versus systemic prophylaxis in TKA: a randomized trial.

Simon W Young, Mei Zhang, Joshua T Freeman, John Mutu-Grigg, Paul Pavlou, Grant A Moore

2 registry-linked trialsAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Clinical orthopaedics and related research, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 31 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
31citing papers in PubMed, 4 pooled it
3.2field-weighted citation impact, top 9% 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
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
3 · Its place in the literature

Who cites it

31 citing papers in PubMed, 4 syntheses or guidelines pooled it, 78 citations in OpenAlex.

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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

6 authors at 3 institutions in 1 country.

Simon W YoungDepartment of Orthopaedics, North Shore Hospital, Private Bag 93-503, Takapuna, Auckland, 0740, New Zealand, simonwyoung@gmail.com.
Mei Zhang
Joshua T Freeman
John Mutu-Grigg
Paul Pavlou
Grant A Moore
North Shore Hospital · NZCanterbury Health Laboratories · NZAuckland City Hospital · NZ

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundIn response to increasing antibiotic resistance, vancomycin has been proposed as an alternative prophylactic agent in TKA. However, vancomycin requires a prolonged administration time, risks promoting further antibiotic resistance, and can cause systemic toxicity. Intraosseous regional administration (IORA) is known to achieve markedly higher antibiotic concentrations than systemic administration and may allow the use of a lower vancomycin dose. QUESTIONS/PURPOSES: We assessed whether low-dose IORA vancomycin can achieve tissue concentrations equal or superior to those of systemic administration in TKA and compared complications between patients treated with IORA and intravenous vancomycin.

methodsWe randomized 30 patients undergoing primary TKA to receive 250 or 500 mg vancomycin via IORA or 1 g via systemic administration. IORA was performed as a bolus injection into a tibial intraosseous cannula below an inflated thigh tourniquet immediately before skin incision. Subcutaneous fat and bone samples were taken during the procedure and antibiotic concentrations measured.

resultsThe overall mean tissue concentration of vancomycin in subcutaneous fat was 14 μg/g in the 250-mg IORA group, 44 μg/g in the 500-mg IORA group, and 3.2 μg/g in the systemic group. Mean concentrations in bone were 16 μg/g in the 250-mg IORA group, 38 μg/g in the 500-mg IORA group, and 4.0 μg/g in the systemic group. One patient in the systemic group developed red man syndrome during infusion.

conclusionsLow-dose IORA vancomycin results in tissue concentrations equal or superior to those of systemic administration. IORA optimizes timing of vancomycin administration, and the lower dose may reduce the risk of systemic side effects while providing equal or enhanced prophylaxis in TKA.

Indexed as

AgedAged, 80 and overAnti-Bacterial AgentsAntibiotic ProphylaxisArthroplasty, Replacement, KneeAwards and PrizesFemaleHumansInfusions, IntraosseousInfusions, IntravenousMaleMiddle AgedVancomycinAnti-Bacterial AgentsVancomycin

Identifiers

PMID23666589
PMCPMC3889447
OpenAlexW1978895230

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.