IO Vancomycin Into the Medial Malleolus vs IV Administration in Revision TKA

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

Inclusion Criteria: * Patient is undergoing a revision total knee arthroplasty where in the opinion of the investigator, the patient's existing tibial component excludes the tibial tubercle as a valid intraosseous injection site. * Patient is able to understand the study design and intervention and gives informed consent to participate in the study. * Age \> 18 years. Exclusion Criteria: * Contraindication to receiving vancomycin, cefepime, ancef, or other standard of care pre-operative antibiotic (allergy, medical issue, etc). * Patient received or is scheduled to receive intravenous Vancomycin within 7 days prior to their planned revision procedure. * Any hardware, condition, or anatomic status that prevents the medial malleolus from being a viable intraosseous injection site. * Refusal to participate * Any condition, in the opinion of the primary investigator, that deems the participant unsuitable for participation in the research study.