IO vs IV Vancomycin in Tourniquetless TKA

NCT ID: NCT05705843

Last Updated: 2023-01-31

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

PHASE4

Total Enrollment

40 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-01-25

Study Completion Date

2024-01-25

Brief Summary

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Purpose of this study is to compare the efficacy of intravenous and intraosseous antibiotic administration techniques during tourniquetless total knee arthroplasty.

Detailed Description

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Primary Objective: Comparable levels of vancomycin will be found in distal femur, proximal tibia, and periarticular soft tissues, as well as in systemic levels, between the intravenous and intraosseous administration groups.

Secondary Objective: Compare 30- and 90-day post-operative complication rates (infection) between the control (standard IV administration of vancomycin) versus the interventional group (intraosseous administration of vancomycin). The research team hypothesizes that there will be no difference in complication (infection) rates between groups

Conditions

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Infection, Surgical Site

Keywords

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Vancomycin Total Knee Arthroplasty Tourniquetless

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

This study is a prospective, randomized, single-blinded, controlled trial. The anticipated total number of participants in this study is 20 patients in each treatment arm: 20 patients will be given IV Vancomycin, 20 patients will be given IO vancomycin. This sample size is based on previous studies examining vancomycin concentration in primary TKA between IO vs IV
Primary Study Purpose

PREVENTION

Blinding Strategy

DOUBLE

Participants Outcome Assessors
* Participant will be blinded to their mode of vancomycin administration.
* Lab will be blinded to which group subject samples come from when doing concentration level testing.

Study Groups

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Intravenous Vancomycin Administration

Patients will receive the Houston Methodist Hospital orthopedic surgery standard of care pre-operative antibiotic regimen for primary total knee arthroplasty patients. This includes IV antibiotics (typically ancef or cefepime and vancomycin) will be started in the pre-operative period approximately 1 hour prior to incision (vancomycin dose weight-based at approximately 15mg/kg \[12,13\] generally 1000-1750mg in 500mL NS).

Group Type ACTIVE_COMPARATOR

Intravenous Vancomycin

Intervention Type DRUG

IV Vancomycin will be started in the pre-operative period approximately 1 hour prior to incision (vancomycin dose weight-based at approximately 15mg/kg generally 1000-1750mg in 500mL NS).

Intraosseous Vancomycin Administration

* IV antibiotics (per physician's standard of care): Typically ancef or cefepime is started in pre-op within 1 hour of incision. IV Vancomycin will not be administered preoperatively in this group.
* IO vancomycin is administered via an intraosseous cannulation device (Arrow EZ-IO; Teleflex, Morrisville, NC) in the OR after sterile prep and draping has occurred prior to skin incision (500mg in 150mL NS).
* Injection will take place into the tibial tubercle (within a pre-specified region) immediately prior to incision.

Group Type EXPERIMENTAL

Intraosseous Vancomycin Injection

Intervention Type DRUG

• IO vancomycin is administered via an intraosseous cannulation device (Arrow EZ-IO; Teleflex, Morrisville, NC) in the OR after sterile prep and draping has occurred prior to skin incision (500mg in 150mL NS).

Interventions

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Intraosseous Vancomycin Injection

• IO vancomycin is administered via an intraosseous cannulation device (Arrow EZ-IO; Teleflex, Morrisville, NC) in the OR after sterile prep and draping has occurred prior to skin incision (500mg in 150mL NS).

Intervention Type DRUG

Intravenous Vancomycin

IV Vancomycin will be started in the pre-operative period approximately 1 hour prior to incision (vancomycin dose weight-based at approximately 15mg/kg generally 1000-1750mg in 500mL NS).

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Patient is undergoing a primary total knee arthroplasty.
* Patient is able to understand the study design and intervention and gives informed consent to participate in the study. No LAR consents will be utilized for this study.
* Age \>18 years.
* Total knee arthroplasty performed without the use of a tourniquet.

Exclusion Criteria

* Previous surgery on the knee (including arthroscopic knee surgery)
* BMI above 35
* Contraindication to receiving vancomycin, cefepime, ancef, or other standard of care pre-operative antibiotic (allergy, medical issue, etc).
* Inability to locate the tibial tubercle or administer the IO infusion
* Refusal to participate
* Uncontrolled Diabetes Mellitus type 1 or 2, defined as Hemoglobin A1C \>7.5.
* Immunocompromised or immunosuppressed patients (HIV, Hep C, End-Stage Renal Disease, dialysis, transplant, chemo/radiation treatment in last 6 months, and immunosuppresive medications)
Minimum Eligible Age

19 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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The Methodist Hospital Research Institute

OTHER

Sponsor Role lead

Responsible Party

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Timothy S. Brown

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Houston Methodist Hospital Outpatient Center

Houston, Texas, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Thomas C Sullivan, BS

Role: CONTACT

Phone: 346-238-1603

Email: [email protected]

Haley Goble, MHA

Role: CONTACT

Phone: 7134413930

Email: [email protected]

Facility Contacts

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Sonya Hadrigan

Role: primary

Other Identifiers

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PRO00035759

Identifier Type: -

Identifier Source: org_study_id