[Results of one-stage endoprosthesis revision in periprosthetic infection cause by methicillin-resistant Staphylococcus aureus].
OBJECTIVE
Are the results of one-stage exchange arthroplasties to treat periprosthetic infection caused by methicillin-resistant Staphylococcus aureus (MRSA) comparable to bacteriologically unselected studies of one-stage exchange operations?


METHODS
From 1996 to 1997 twenty patients with a periprosthetic infection caused by methicillin-resistant Staphylococcus aureus (MRSA) were treated at the ENDO-Klinik by an one-stage exchange arthroplasty. Mean follow-up of fifteen one-stage exchange total hip replacements and 5 one-stage exchange total knee replacements was 16 months. The patients were examined by means of clinical, laboratory-chemical and radiological tests. In addition, postoperative joint aspiration was performed on 14 patients.


RESULTS
In 11 cases (61%) the periprosthetic infection was treated successfully with only one one-stage exchange operation. In cases with persisting infection the period between the first exchange arthroplasty and the repeated clinical manifestation of the infection (second exchange operation) was 2 months on average. 93% of the joint aspirations (n = 14), performed on average 4 weeks postoperatively, correlated with the result of the follow-up tests.


CONCLUSIONS
Periprosthetic infection with MRSA is a problematic infection. Because of the reduced therapeutic possibilities it is associated with a higher rate of recurrence than the unselected group of patients as a whole [6, 11, 16, 17, 19, 20]. The authors recommend one-stage exchange arthroplasty using a combination of vancomycin and ofloxacin as admixture to polymethylmethacrylat (Refobacin Palacos R). This procedure does, however, need further development. Intraoperative use of an antiseptic and systemic administration of rifampicin, as recommended by Zimmerli [23] is a further possibility.
Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA.
J
J
Kordelle
L
L
Frommelt
D
D
Klüber
K
K
Seemann
D000368:Aged; D000369:Aged, 80 and over; D001843:Bone Cements; D005260:Female; D005839:Gentamicins / Q000008:administration & dosage; D006622:Hip Prosthesis; D006801:Humans; D007720:Knee Prosthesis; D008297:Male; D016106:Methicillin Resistance; D008768:Methylmethacrylates / Q000008:administration & dosage; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D013203:Staphylococcal Infections / Q000601:surgery*
D001843:Bone Cements; D005839:Gentamicins; D008768:Methylmethacrylates; C030159:gentamicin-polymethylmethacrylate bead