Intraosseous vancomycin injection during hip arthroplasty leads to higher concentrations and lower systemic levels of the drug with no complications.

Total hip arthroplasty (THA) is a common surgical procedure that involves replacing a damaged or arthritic hip joint with an artificial one. Proper infection prophylaxis is crucial during such procedures, and antibiotics play a vital role in preventing and treating infections. However, administering antibiotics during THA can be challenging, particularly in patients with limited venous access. In such cases, intraosseous injection has emerged as a promising alternative route for administering antibiotics. This article explores the potential benefits of intraosseous injection in sustaining vancomycin levels in tissues during THA.


According to a study presented at the Hip Society Specialty Day as part of the American Academy of Orthopaedic Surgeons Annual Meeting, patients who underwent total hip arthroplasty who received an intraosseous vancomycin injection had higher concentrations of vancomycin and significantly lower systemic vancomycin levels. Dr. Katharine D. Harper, the lead author of the study, said that the technique could be expanded to many different procedures, including joint arthroplasties throughout the body and fracture care. The study, which won the Otto Aufranc Award, randomly assigned 20 patients to receive either IV vancomycin or an intraosseous vancomycin injection, which was an intraosseous infusion to the greater trochanter at the time of surgical incision. All patients also received IV cephalosporin within one hour of incision. Researchers collected serum vancomycin levels and soft tissue samples from the gluteus maximus at the beginning and end of the procedure, as well as tissue samples within the acetabulum immediately after hip dislocation. Once samples were collected, they were minced and then weighed. Vancomycin tissue concentrations were measured using high-performance liquid chromatography. Vancomycin blood analyses were performed by standard-level lab testing, and then they were compared using standard t-tests. Intraosseous levels were undetectable systemically at the beginning of the procedure and only minimally detectable at the end of the procedure. However, IV vancomycin levels were significantly detected. Tissue samples from the intraosseous infusion group had higher vancomycin concentrations vs. tissue samples in the IV fusion group, which was statistically significant in the acetabulum and approached significance in the medical calcar. There were no 90-day complications reported in either group. The research team concluded that intraosseous vancomycin injection resulted in superior tissue concentrations in affected regions and improved efficacy over standard IV administration. The results have important implications for patients undergoing total hip arthroplasty and related procedures.


In conclusion, the use of intraosseous injection as a route of administration for vancomycin during total hip arthroplasty may prove to be a promising alternative to traditional methods such as intravenous or irrigation. This technique helps sustain optimal vancomycin levels in tissues and reduces the risk of infection in surgical sites. While further studies are needed to validate the effectiveness of intraosseous injection in clinical settings, the preliminary findings present a helpful addition to the orthopedic surgeon’s arsenal for combatting infections related to THA. As with any medical procedure, careful evaluation and implementation by qualified healthcare professionals are necessary to ensure the safety and efficacy of intraosseous injections during surgery.