Tourniquet use may impact antibiotic tissue concentration during TKA
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Key takeaways:
- Antibiotic tissue concentrations may be lower among patients who undergo TKA with a tourniquet vs. without it.
- Tourniquet use may inhibit the ability of antibiotics to cover pathogens responsible for infection.
Use of a tourniquet may reduce local tissue concentrations of cefazolin, which could increase the risk of periprosthetic joint infection for patients undergoing total knee arthroplasty, according to published data.
Julien Montreuil, MD, MSc, orthopedic surgeon from the division of orthopedic surgery at McGill University in Montreal, and colleagues performed a prospective, randomized clinical trial of 59 patients who underwent primary TKA between March 2022 and June 2023.
Montreuil and colleagues randomly assigned 29 patients to undergo surgery with a tourniquet and 30 patients to undergo surgery without a tourniquet. According to the study, they used liquid chromatography-tandem mass spectrometry to assess the local tissue concentration of cefazolin in fat, synovium and bone at 60 minutes after infusion.
Compared with no tourniquet, the use of a tourniquet was associated with significantly lower mean local tissue concentrations at 60 minutes after infusion in fat (16.9 μg/g vs. 10.8 μg/g), synovium (25.8 μg/g vs. 18.9 μg/g) and bone (19.4 μg/g vs. 11.8 μg/g).
Montreuil and colleagues noted the mean local tissue concentration for patients in the tourniquet group was insufficient to cover pathogens with high minimum inhibitory concentrations such as coagulase-negative staphylococci and other pathogens responsible for PJI.
“The study underscores the adverse effect of tourniquet inflation on tissue concentration of antibiotics and raises questions regarding cefazolin’s effectiveness against pathogens with higher minimum inhibitory concentrations,” Montreuil and colleagues wrote in the study.
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