title: Intra-articular infusion: a direct approach to treatment of infected total knee arthroplasty.
abstract: Bactericidal levels of antibiotics are difficult to achieve in infected total joint arthroplasty when intravenous antibiotics or antibiotic-loaded cement spacers are used, but intra-articular (IA) delivery of antibiotics has been effective in several studies. This paper describes a protocol for IA delivery of antibiotics in infected knee arthroplasty, and summarises the results of a pharmacokinetic study and two clinical follow-up studies of especially difficult groups: methicillin-resistant Staphylococcus aureus and failed two-stage revision. In the pharmacokinetic study, the mean synovial vancomycin peak level was 9242 (3956 to 32 150; sd 7608 μg/mL) among the 11 patients studied. Serum trough level ranged from 4.2 to 25.2 μg/mL (mean, 12.3 μg/mL; average of 9.6% of the joint trough value), which exceeded minimal inhibitory concentration. The success rate exceeded 95% in the two clinical groups. IA delivery of antibiotics is shown to be safe and effective, and is now the first option for treatment of infected total joint arthroplasty in our institution.
authors.affiliation: Missouri Bone and Joint Research Foundation, 1000 Des Peres Rd., Suite 120, St. Louis, Missouri, 63131, USA.
authors.forename: L A
authors.initials: LA
authors.lastname: Whiteside
authors.affiliation: Missouri Bone and Joint Research Foundation, 1000 Des Peres Rd., Suite 120, St. Louis, Missouri, 63131, USA.
authors.forename: M E
authors.initials: ME
authors.lastname: Roy
authors.affiliation: Medstar Haarbor Orthopaedics, 2900 S. Hanover Street, Baltimore, MD 21225, USA.
authors.forename: T A
authors.initials: TA
authors.lastname: Nayfeh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D036502:Infusions, Intralesional; D007270:Injections, Intra-Articular; D007720:Knee Prosthesis / Q000009:adverse effects*; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000188:drug therapy* / Q000209:etiology*; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000209:etiology
chemical_list: D000900:Anti-Bacterial Agents
keywords: MRSA; infection; intraarticular antibiotics; revision; total knee arthroplasty