One-stage Revision With Catheter Infusion of Intraarticular Antibiotics Successfully Treats Infected THA

Abstract

Background Two-stage revision surgery for infected total hip arthroplasty (THA) is commonly advocated, but substantial morbidity and expense are associated with this technique. In certain cases of infected THA, treatment with one-stage revision surgery and intraarticular infusion of antibiotics may offer a reasonable alternative with the distinct advantage of providing a means of delivering the drug in high concentrations. Questions/purposes We describe a protocol for intraarticular delivery of antibiotics to the hip through an indwelling catheter combined with one-stage revision surgery and examine (1) the success as judged by eradication of infection at 1 year when treating chronically infected cemented stems; (2) success in treating late-onset acute infections in well-ingrown cementless stems; and (3) what complications were associated with this approach in a small case series. Methods Between

Local Vancomycin Concentrations after Intra-articular Injection into the Knee Joint: An Experimental Porcine Study

“…Intra-articular injection of vancomycin has also been associated with positive effect in the treatment of PJI. 12,29 This parallels the increased focus on local antimicrobial application in the treatment of bone infections, [30][31][32] as progression of infection and inflammation has shown to lower the antimicrobial bone penetration after systemic administration. 14,17,33 The measurements in the present study were obtained from noninfected and noninflamed porcine tissue, and thus not translational to an infectious clinical setting.…”

Treatment Options and Outcomes of Vancomycin-Resistant Enterococcus in prosthetic joint infections: Case Report and Potential Implications for Military Cases

“…A one-stage revision with placement of Hickman catheters allows for higher rates of microbiologic cure, characterized by negative follow-up synovial fluid cultures in patients with susceptible pathogens (3). Most significantly, the use of catheters supplying intraarticular antibiotics allows possible improvement of arthroplasty salvage rates and less limb loss, as compared to more traditional twostage revision (3,(19)(20)(21).…”

“…High levels of antibiotic may overcome the resistance mechanisms of the bacteria, and thus the minimum inhibitory concentration, without causing systemic toxicity (3,20,21). The concentrations in adjacent bone are also higher via intraarticular antibiotics as compared to intravenous administration (9,20,21).…”

“…The concentrations in adjacent bone are also higher via intraarticular antibiotics as compared to intravenous administration (9,20,21). Specifically, intraarticular daptomycin has been used successfully once to our knowledge for VRE-associated PJI (3).…”

New developments and future challenges in prevention, diagnosis, and treatment of prosthetic joint infection

“…Additionally, antibiotic‐impregnated calcium sulfate beads did not improve outcomes after debridement and implant retention in acute PJI 113 . Another method of local antibiotic delivery by an intra‐articular catheter showed some success in a limited number of patients 114 . Well‐controlled studies are still needed to justify the added cost, risk of resistant organisms, and morbidity of additional local antibiotic therapy to treat PJI.…”