{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T06:56:15Z","timestamp":1792133775371,"version":"4.4.0"},"reference-count":23,"publisher":"Bioscientifica","issue":"3","license":[{"start":{"date-parts":[[2023,3,1]],"date-time":"2023-03-01T00:00:00Z","timestamp":1677628800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["eor.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,3,1]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:list list-type=\"bullet\">\n                      <jats:list-item>\n                        <jats:p>Surgical site infection (SSI) is a rare and serious complication of total knee arthroplasty (TKA), which causes a poor prognosis for patients. The purpose of this study was to explore the effect of intraosseous (IO) antibiotics in preventing infection and complications after TKA compared with intravenous (IV) antibiotics and to provide a certain theoretical basis for clinical treatment.<\/jats:p>\n                      <\/jats:list-item>\n                    <\/jats:list>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:list list-type=\"bullet\">\n                      <jats:list-item>\n                        <jats:p>The review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched the PubMed, Embase, Ovid, Web of Science, and the Cochrane Central Register of Controlled Trials databases about trials on IO antibiotics (into the proximal tibia before skin incision) to prevent infections in TKA from the respective inception dates to September 30, 2022. The infection occurred within 3 months after surgery. Both researchers individually screened the studies in accordance with the inclusion and exclusion criteria, performed the literature quality evaluation and data extraction, and used Stata 17 software for data analysis.<\/jats:p>\n                      <\/jats:list-item>\n                    <\/jats:list>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:list list-type=\"bullet\">\n                      <jats:list-item>\n                        <jats:p>\n                          Five studies that enrolled 3801 patients were included in this meta-analysis. The results showed that IO antibiotics were effective in reducing the incidence of SSI (OR: 0.25,\n                          <jats:italic>P<\/jats:italic>\n                          \u2009=\u20090.001) and periprosthetic joint infections (OR: 0.16,\n                          <jats:italic>P<\/jats:italic>\n                          \u2009=\u20090.004) relative to IV. Moreover, the percentage of infection due to Gram-positive bacteria (OR: 0.18,\n                          <jats:italic>P<\/jats:italic>\n                          \u2009=\u20090.025) was reduced in the IO group compared with that in IV group, but Gram-negative bacteria levels were not significantly reduced (\n                          <jats:italic>P<\/jats:italic>\n                          \u2009=\u20090.14). There was no difference between the two groups for other systemic adverse effects of the drug.\n                        <\/jats:p>\n                      <\/jats:list-item>\n                    <\/jats:list>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:list list-type=\"bullet\">\n                      <jats:list-item>\n                        <jats:p>IO antibiotics in TKA are safe and effective alternatives to IV antibiotics. Large randomized clinical studies comparing infection rates and related complications with IO and IV antibiotics are required.<\/jats:p>\n                      <\/jats:list-item>\n                    <\/jats:list>\n                  <\/jats:sec>","DOI":"10.1530\/eor-22-0130","type":"journal-article","created":{"date-parts":[[2023,3,14]],"date-time":"2023-03-14T08:11:20Z","timestamp":1678781480000},"page":"127-134","update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-16","source":"Crossref","is-referenced-by-count":12,"title":["Intraosseous regional prophylactic antibiotics decrease the risk of infection in total knee arthroplasty compared with intravenous antibiotics: a systematic review and meta-analysis"],"prefix":"10.1530","volume":"8","author":[{"given":"Xinhuan","family":"Lei","sequence":"first","affiliation":[{"name":"Department of Orthopedic, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, Zhejiang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Xiang","sequence":"additional","affiliation":[{"name":"Department of Orthopedic, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, Zhejiang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hailan","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Ultrasound, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, Zhejiang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1309-5315","authenticated-orcid":true,"given":"Hongya","family":"Bao","sequence":"additional","affiliation":[{"name":"Department of Orthopedic, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, Zhejiang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4099-6570","authenticated-orcid":true,"given":"Zhong","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Orthopedic, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, Zhejiang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hua","family":"Luo","sequence":"additional","affiliation":[{"name":"Department of Orthopedic, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, Zhejiang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","reference":[{"key":"bib1","series-title":"Clinical Orthopaedics and Related Research","first-page":"3486","article-title":"Are bone and serum cefazolin concentrations adequate for antimicrobial prophylaxis?","volume":"469","author":"Yamada","year":"2011","unstructured":"Yamada KMatsumoto KTokimura FOkazaki H & Tanaka S. Are bone and serum cefazolin concentrations adequate for antimicrobial prophylaxis?Clinical Orthopaedics and Related Research20114693486\u20133494. (https:\/\/doi.org\/10.1007\/s11999-011-2111-8)"},{"key":"bib2","series-title":"Clinical Orthopaedics and Related Research","first-page":"244","article-title":"Higher cefazolin concentrations with intraosseous regional prophylaxis in TKA","volume":"471","author":"Young","year":"2013","unstructured":"Young SWZhang MFreeman JTVince KG & Coleman B. Higher cefazolin concentrations with intraosseous regional prophylaxis in TKA. Clinical Orthopaedics and Related Research2013471244\u2013249. (https:\/\/doi.org\/10.1007\/s11999-012-2469-2)"},{"issue":"Supplement A","key":"bib3","series-title":"Bone and Joint Journal","first-page":"13","article-title":"2021 Chitranjan S. Ranawat Award: intraosseous vancomycin reduces periprosthetic joint infection in primary total knee arthroplasty at 90-day follow-up","volume":"103\u2013B","author":"Park","year":"2021","unstructured":"Park KJChapleau JSullivan TCClyburn TA & Incavo SJ. 2021 Chitranjan S. Ranawat Award: intraosseous vancomycin reduces periprosthetic joint infection in primary total knee arthroplasty at 90-day follow-up. Bone and Joint Journal2021103\u2013B(Supplement A) 13\u201317. (https:\/\/doi.org\/10.1302\/0301-620X.103B6.BJJ-2020-2401.R1)"},{"key":"bib4","series-title":"Clinical Orthopaedics and Related Research","first-page":"2504","article-title":"Intraosseous regional prophylactic antibiotics decrease the risk of prosthetic joint infection in primary TKA: a multicenter study","volume":"479","author":"Parkinson","year":"2021","unstructured":"Parkinson BMcEwen PWilkinson MHazratwala KHellman JKhan HMcLean APanwar YDoma K & Grant A. 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(https:\/\/doi.org\/10.1186\/s12891-019-2432-4)"},{"key":"bib13","series-title":"Bone and Joint Journal","first-page":"1060","article-title":"Estimating incidence rates of periprosthetic joint infection after hip and knee arthroplasty for osteoarthritis using linked registry and administrative health data","volume":"104\u2013B","author":"Jin","year":"2022","unstructured":"Jin XGallego Luxan BHanly MPratt NLHarris Ide Steiger RGraves SE & Jorm L. Estimating incidence rates of periprosthetic joint infection after hip and knee arthroplasty for osteoarthritis using linked registry and administrative health data. Bone and Joint Journal2022104\u2013B1060\u20131066. (https:\/\/doi.org\/10.1302\/0301-620X.104B9.BJJ-2022-0116.R1)"},{"key":"bib14","series-title":"Journal of Arthroplasty","first-page":"3238","article-title":"Are we winning or losing the battle with periprosthetic joint infection: trends in periprosthetic joint infection and mortality risk for the medicare population","volume":"33","author":"Kurtz","year":"2018","unstructured":"Kurtz SMLau ECSon MSChang ETZimmerli W & Parvizi J. Are we winning or losing the battle with periprosthetic joint infection: trends in periprosthetic joint infection and mortality risk for the medicare population. Journal of Arthroplasty2018333238\u20133245. (https:\/\/doi.org\/10.1016\/j.arth.2018.05.042)"},{"key":"bib15","series-title":"International Orthopaedics","first-page":"505","article-title":"The microbiology of the infected knee arthroplasty","volume":"34","author":"Nickinson","year":"2010","unstructured":"Nickinson RSBoard TNGambhir AKPorter ML & Kay PR. The microbiology of the infected knee arthroplasty. International Orthopaedics201034505\u2013510. (https:\/\/doi.org\/10.1007\/s00264-009-0797-y)"},{"key":"bib16","series-title":"American Journal of Health-System Pharmacy","first-page":"195","article-title":"Clinical practice guidelines for antimicrobial prophylaxis in surgery","volume":"70","author":"Bratzler","year":"2013","unstructured":"Bratzler DWDellinger EPOlsen KMPerl TMAuwaerter PGBolon MKFish DNNapolitano LMSawyer RGSlain D, Clinical practice guidelines for antimicrobial prophylaxis in surgery. American Journal of Health-System Pharmacy201370195\u2013283. (https:\/\/doi.org\/10.2146\/ajhp120568)"},{"key":"bib17","series-title":"Clinical Orthopaedics and Related Research","first-page":"57","article-title":"The Mark Coventry Award: higher tissue concentrations of vancomycin with low-dose intraosseous regional versus systemic prophylaxis in TKA: a randomized trial","volume":"472","author":"Young","year":"2014","unstructured":"Young SWZhang MFreeman JTMutu-Grigg JPavlou P & Moore GA. The Mark Coventry Award: higher tissue concentrations of vancomycin with low-dose intraosseous regional versus systemic prophylaxis in TKA: a randomized trial. Clinical Orthopaedics and Related Research201447257\u201365. (https:\/\/doi.org\/10.1007\/s11999-013-3038-z)"},{"key":"bib18","series-title":"American Journal of Health-System Pharmacy","first-page":"82","article-title":"Therapeutic monitoring of vancomycin in adult patients: a consensus review of the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists","volume":"66","author":"Rybak","year":"2009","unstructured":"Rybak MLomaestro BRotschafer JCMoellering RJrCraig WBilleter MDalovisio JR & Levine DP. Therapeutic monitoring of vancomycin in adult patients: a consensus review of the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists. American Journal of Health-System Pharmacy20096682\u201398. (https:\/\/doi.org\/10.2146\/ajhp080434)"},{"key":"bib19","series-title":"Journal of Bone and Joint Surgery. American Volume","first-page":"1819","article-title":"The rate of acute kidney injury after total hip arthroplasty is low but increases significantly in patients with specific comorbidities","volume":"99","author":"Gharaibeh","year":"2017","unstructured":"Gharaibeh KAHamadah AMSierra RJLeung NKremers WK & El-Zoghby ZM. The rate of acute kidney injury after total hip arthroplasty is low but increases significantly in patients with specific comorbidities. Journal of Bone and Joint Surgery. American Volume2017991819\u20131826. (https:\/\/doi.org\/10.2106\/JBJS.16.01027)"},{"key":"bib20","series-title":"Open Forum Infectious Diseases","article-title":"Acute tubular necrosis associated with high serum vancomycin and tobramycin levels after revision of total knee arthroplasty with antibiotic-containing calcium sulfate beads","volume":"6","author":"Ma","year":"2019","unstructured":"Ma AHHoffman C & McNeil JI. 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