Introduction: Antibiotic prophylaxis is a standard practice in prosthetic orthopaedic surgery. In total knee arthroplasty (TKA), several surgeons routinarily use a tourniquet to interrupt the blood circulation of the leg to be operated. The penetration of systemically given antibiotics is reduced by the tourniquet. To avoid this problem, some authors administered the antibiotic in a leg vein, after tourniquet inflation, to enhance antibiotic penetration in the operative field. We reviewed the available literature about the use of regional prophylaxis in TKA.

Materials and methods: The medical literature was seeked by means of the PubMed (National Library of Medicine, Washington, USA) research engine. The keywords «prophylaxis», «knee» «arthroplasty», «regional» were used in various combinations.

Results: In 1990, Hoddinott et Al. compared the bone and fat penetration of two cephalosporins (cefaman-dole and cefuroxime) given either by the systemic and the regional route, and found the concentrations after regional administration significantly higher.

A similar result was confirmed by Field et Al. in 1992.

In 1993, de Lalla et Al. compared the systemic administration of 800 mg teicoplanin with the regional administration of 400 mg teicoplanin, and found higher levels of drug in the tissues of the operative field after regional administration.

In 2000, the same authors enrolled 205 prostheses in a clinical trial to assess the efficacy of the regional prophylaxis with 400 mg teicoplanin, and did not record any prosthetic infection.

In 2001, Lazzarini et Al. reviewed 217 patients who received regional prophylaxis with 400 mg teicoplanin for TKA, and found 8 (2.9%) surgical site infections, mostly occurring in patients with previous TKA.

In 2003, Lazzarini et Al. compared the tissue levels of teicoplanin after systemic administration of 800 mg and after the regional administration of 200 mg. The tissue levels after regional administration were still higher than those after systemic administration.

Conclusion: There is a good evidence for the use of regional prophylaxis when a tourniquet is used for TKA.