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This study aimed to evaluate the tissue concentration and systemic concentration of preoperative stand-alone intraosseous cefuroxime in robotic-assisted total knee arthroplasty (RA-TKA) and identify a candidate dose for further evaluation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Thirty-nine patients undergoing MAKO RA-TKA were randomly allocated in a 1:1:1 ratio to receive intraosseous cefuroxime 750\u00a0mg (R750\n                      <jats:sub>IO<\/jats:sub>\n                      ), intraosseous cefuroxime 1,500\u00a0mg (R1500\n                      <jats:sub>IO<\/jats:sub>\n                      ), or intravenous cefuroxime 1,500\u00a0mg (R1500\n                      <jats:sub>IV<\/jats:sub>\n                      ). No additional intravenous antibiotics were administered before incision or during surgery. During surgery, nine tissue samples were collected: bone samples from the femur or tibia, synovial and fat samples from the surgical area, and systemic blood samples twice for cefuroxime level detection. Intraoperative vital signs, inflammatory markers on days 1 and 3 postoperative, and complications within 3\u00a0months were recorded.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The final analysis included 38 patients: 13 in the R750\n                      <jats:sub>IO<\/jats:sub>\n                      group, 13 in the R1500\n                      <jats:sub>IO<\/jats:sub>\n                      group, and 12 in the R1500\n                      <jats:sub>IV<\/jats:sub>\n                      group. Compared with the R1500\n                      <jats:sub>IV<\/jats:sub>\n                      group, both R1500\n                      <jats:sub>IO<\/jats:sub>\n                      and R750\n                      <jats:sub>IO<\/jats:sub>\n                      groups showed significantly higher tissue concentrations (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05) but lower initial blood concentrations (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05). While the R1500\n                      <jats:sub>IO<\/jats:sub>\n                      group had higher tissue concentrations than the R750\n                      <jats:sub>IO<\/jats:sub>\n                      group, its post-tourniquet-release blood concentration was significantly higher (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.005). No significant differences were found in postoperative inflammatory markers and intraoperative vital signs among the three groups (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&gt;\u20090.05), and no complications occurred within 3\u00a0months.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Despite multiple intramedullary pins and longer operative time in robot-assisted TKA, a single intraosseous dose of cefuroxime still achieved high tissue concentrations. Compared to conventional intravenous infusion of 1,500\u00a0mg cefuroxime, preoperative stand-alone intraosseous administration of either 750\u00a0mg or 1,500\u00a0mg cefuroxime achieved higher local tissue concentrations. Moreover, the 750\u00a0mg intraosseous regimen was associated with a lower post-tourniquet-release systemic concentration than the 1,500\u00a0mg intraosseous regimen, supporting its further clinical evaluation as a candidate dose in RA-TKA.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s42836-026-00436-0","type":"journal-article","created":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T23:02:00Z","timestamp":1792364520000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Higher tissue concentrations of cefuroxime achieved with preoperative stand-alone intraosseous regional prophylaxis in robotic-assisted total knee arthroplasty: a randomized controlled trial"],"prefix":"10.1186","volume":"8","author":[{"given":"Te","family":"Liu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heng","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming","family":"Guo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Runkai","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ye","family":"Tao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhuo","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guoqiang","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Fu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3910-0127","authenticated-orcid":false,"given":"Ming","family":"Ni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,19]]},"reference":[{"issue":"6 Supple A","key":"436_CR1","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1302\/0301-620X.103B6.BJJ-2020-2401.R1","volume":"103-B","author":"KJ Park","year":"2021","unstructured":"Park KJ, Chapleau J, Sullivan TC, Clyburn TA, Incavo SJ. 2021 Chitranjan S. 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Higher cefazolin concentrations in synovial fluid with intraosseous regional prophylaxis in knee arthroplasty: a randomized controlled trial. Arch Orthop Trauma Surg. 144(9):4069\u20134075.","DOI":"10.1007\/s00402-023-05108-1"}],"container-title":["Arthroplasty"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s42836-026-00436-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s42836-026-00436-0","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s42836-026-00436-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T23:02:02Z","timestamp":1792364522000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s42836-026-00436-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,19]]},"references-count":46,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["436"],"URL":"https:\/\/doi.org\/10.1186\/s42836-026-00436-0","relation":{},"ISSN":["2524-7948"],"issn-type":[{"value":"2524-7948","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,19]]},"assertion":[{"value":"23 April 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 September 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 October 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This prospective study was approved by the Ethics Committee of PLA General Hospital (approval number: S2023-332-02) and was conducted in accordance with the Declaration of Helsinki and institutional and national research committee standards. Written informed consent was obtained from all participants. This study has been registered with the Chinese Clinical Trial Registry (ChiCTR;\n                      \n                      ; registration number: ChiCTR2400080681; registered on February 4, 2024).","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Guoqiang Zhang serves on the editorial board of Arthroplasty and had no role in the journal\u2019s review or editorial decision-making for this manuscript. The remaining authors declare that they have no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"81"}}