, Volume 469, Issue 1, pp 26-33
Date: 14 Apr 2010

Methicillin-resistant Staphylococcus aureus in TKA Treated With Revision and Direct Intraarticular Antibiotic Infusion

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Abstract

Background

Resistant organisms are difficult to eradicate in infected total knee arthroplasty. While most surgeons use antibiotic-impregnated cement in these revisions, the delivery of the drug in adequate doses is limited in penetration and duration. Direct infusion is an alternate technique.

Questions/purposes

We asked whether single-stage revision and direct antibiotic infusion for infected TKA would control infection in patients with methicillin-resistant Staphylococcus aureus (MRSA) infections.

Methods

We retrospectively reviewed 18 patients (18 knees) with MRSA with one-stage revision protocol that included débridement, uncemented revision of total knee components, and intraarticular infusion of 500 mg vancomycin via Hickman catheter once or twice daily for 6 weeks; we used no intravenous antibiotics after the first 24 hours. We monitored serum vancomycin levels to maintain levels between 3 and 10 μg/mL. Minimum followup was 27 months (range, 27–75 months). Mean followup was 62 months, (range, 27–96 months).

Results

Infection was controlled at last followup in all but one patient with a recurrence of the MRSA. The patient was reoperated at 5 months; a necrotic bone fragment was removed, the knee was débrided and revised, and the antibiotic infusion protocol readministered. The patient remained free of infection 42 months postoperatively. At 2-year followup, the mean Knee Society score was 83. We observed no radiographic evidence of implant migration.

Conclusions

One-stage revision and 6 weeks of intraarticular vancomycin administration controlled infection in MRSA infected TKA with no apparent complications.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
Each author certifies that his or her institution approved the research protocol, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.
An Institutional Review Board and hospital committee reviewed and approved the protocol for this study when it was undertaken.
This work was performed at Missouri Bone and Joint Research Foundation.