2024 COA Annual Meeting: Effect of Tourniquet on Local Tissue Concentrations of Cefazolin During Total Knee Arthroplasty: A Randomized Clinical Trial

Sixty-one patients with primary total knee arthroplasty (TKA) were randomized to receive surgery with a tourniquet or without a tourniquet. The outcomes of interest included the local tissue concentration (LTC) of Cefazolin in fat, synovium, and bone, and the systemic concentration of Cefazolin in serum. Outcomes were assessed at regular intervals during surgery. Overall, the results of the study revealed that the use of a tourniquet significantly reduced the LTC of Cefazolin in all three tissue types (fat p=0.001, synovium p=0.03, bone p=0.007). This suggests that while systemic serum levels of Cefazolin are maintained, tourniquet use may cause local tissue levels to be insufficient for effective prophylaxis against periprosthetic joint infections (PJI).