Clinical Orthopaedics and Related Research®

, Volume 469, Issue 1, pp 26–33

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

  • Leo A. Whiteside
  • Michael Peppers
  • Tariq A. Nayfeh
  • Marcel E. Roy
Symposium: Papers Presented at the Annual Meetings of the Knee Society



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.


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.


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).


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.


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.


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Copyright information

© The Association of Bone and Joint Surgeons® 2010

Authors and Affiliations

  • Leo A. Whiteside
    • 1
    • 2
  • Michael Peppers
    • 3
  • Tariq A. Nayfeh
    • 4
  • Marcel E. Roy
    • 2
  1. 1.Missouri Bone and Joint CenterSt LouisUSA
  2. 2.Missouri Bone and Joint Research FoundationSt LouisUSA
  3. 3.Walgreens-Option CareSt LouisUSA
  4. 4.Johns Hopkins College of MedicineBaltimoreUSA

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