Preventing Infection in Total Knee Arthroplasty: Intraosseous Administration of Prophylactic Antibiotics

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dc.contributor.advisor Pitto, R en Young, Simon en 2017-12-11T20:08:24Z en 2017 en
dc.identifier.uri en
dc.description.abstract Aims The aim of the research underpinning this thesis was to investigate the use of prophylactic antibiotics by intraosseous regional administration (IORA) in total knee arthroplasty (TKA) patients . The research aimed to identify which organisms cause periprosthetic joint infection (PJI), the relative importance of PJI as a failure mechanism in TKA, compared the tissue concentrations of cefazolin and vancomycin achieved via the IORA route versus systemic administration in primary and revision TKA, and whether IORA provides more effective prophylaxis in a murine model of TKA. Methods Six studies are presented. Two studies retrospectively reviewed patients who underwent TKA across three public hospitals in Auckland to identify the mechanisms of TKA failure and the causative organisms in PJI. Three prospective randomised clinical trials compared tissue concentrations of cefazolin and vancomycin achieved with IORA versus systemic administration in both primary and revision TKA. Antibiotic prophylaxis by IORA is given 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 were measured using high-performance liquid chromatography. Finally, the effectiveness of antibiotic prophylaxis delivered by IORA was investigated in a mouse model of TKA. Findings The most common reason for revision following TKA over 15 years was PJI, and the most common infecting organisms were coagulase-negative staphylococci (CoNS). Ninety-two percent of CoNS strains were resistant to cefazolin, the antibiotic typically used for prophylaxis in TKA. The mean tissue concentrations of antibiotics in subcutaneous fat and bone were 4–10 times higher with IORA than with systemic administration in both primary and revision TKA. These differences were consistent across all sample time points. In the murine model of TKA, vancomycin delivered via IORA afforded the most effective prophylaxis against PJI. Conclusions PJI is the dominant cause of failure in modern TKA, and most infections are caused by bacteria resistant to commonly used prophylactic agents. When antibiotic prophylaxis is delivered via IORA, markedly higher tissue antibiotic concentrations are achieved. IORA has the potential to enhance the effectiveness of prophylaxis to prevent PJI in TKA. en
dc.publisher ResearchSpace@Auckland en
dc.relation.ispartof PhD Thesis - University of Auckland en
dc.relation.isreferencedby UoA99265056412602091 en
dc.rights Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated. Previously published items are made available in accordance with the copyright policy of the publisher. en
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dc.title Preventing Infection in Total Knee Arthroplasty: Intraosseous Administration of Prophylactic Antibiotics en
dc.type Thesis en Medicine en The University of Auckland en Doctoral en PhD en
dc.rights.holder Copyright: The author en
dc.rights.accessrights en
pubs.elements-id 719056 en Medical and Health Sciences en School of Medicine en Surgery Department en
pubs.record-created-at-source-date 2017-12-12 en

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