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

• Published in: Clinical orthopaedics and related research 2011-01, Vol.469 (1), p.26-33
• Main Authors: Whiteside, Leo A., Peppers, Michael, Nayfeh, Tariq A., Roy, Marcel E.
• Format: Article
• Language: English
• Subjects: Antibiotics; Arthroplasty (knee); Bone; Catheters; Cement; Conservative Orthopedics; Drug delivery; Drug resistance; Infection; Intravenous administration; Knee; Medicine; Medicine & Public Health; Migration; Orthopedics; Sports Medicine; Staphylococcus aureus; Surgery; Surgical Orthopedics; Symposium: Papers Presented at the Annual Meetings of the Knee Society; Vancomycin
• ISSN: 0009-921X; 1528-1132
• DOI: 10.1007/s11999-010-1313-9

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.