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Clinical Research
Exploring Intraosseous
Drug Delivery
In the evolving landscape of surgical recovery and infection control, Houston Methodist is at the forefront of research exploring intraosseous (IO) drug delivery—a method that involves injecting medication directly into the bone marrow.
This technique offers the potential for more targeted, efficient treatment compared to traditional intravenous (IV) routes. Four ongoing and recent clinical trials are paving the way for IO delivery to become a standard of care in orthopedic surgery, addressing both pain management and infection prevention.
The first two studies focus on joint replacement surgery, particularly ankle and knee arthroplasties. In the Total Ankle Arthroplasty trial, led by Jason Ahuero, MD, Assistant Professor of Clinical Orthopedic Surgery, researchers are comparing IO versus IV administration of vancomycin in a Phase IV setting. The trial aims to determine whether delivering antibiotics directly into the bone reduces infection risk more effectively than IV delivery, without increasing complications.
“Given that ankle replacements have relatively high infection risk due to limited soft tissue coverage, this investigation could meaningfully shift perioperative protocols,” said Ahuero
Jason Ahuero, MD
This approach aligns with broader enhanced recovery after surgery (ERAS) protocols and addresses a critical public health challenge: opioid overuse.
Robert Jack, MD
Assistant Professor
Clinical Orthopedic Surgery
In the Lumbar Spine IO Vancomycin trial, led by Mark Prasarn, MD, orthopedic surgeon, IO antibiotic delivery is being explored in a multi-phase study. Lumbar fusions carry a notable infection risk due to long surgical durations and hardware implantation.
“By injecting vancomycin directly into local bone around the spine, we hope to achieve higher local antibiotic levels with fewer systemic effects,” said Prasarn. A strategy that may also reduce complications such as nephrotoxicity associated with IV vancomycin.
Across all four trials, the core question is the same: can intraosseous delivery enhance treatment precision while improving patient safety and recovery? The early data suggest promising answers. These studies not only reflect Houston Methodist’s commitment to innovation but may also influence orthopedic practice nationwide, offering new tools to combat infection, minimize opioid use, and accelerate recovery.
H. Lander, PhD
July 2025
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