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

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.