Intra-articular infusion

a direct approach to treatment of infected total knee arthroplasty

L. A. Whiteside, M. E. Roy, T. A. Nayfeh

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)31-36
Number of pages6
JournalBone and Joint Journal
Volume98-B
Issue number1
DOIs
StatePublished - Jan 1 2016
Externally publishedYes

Fingerprint

Knee Replacement Arthroplasties
Joints
Anti-Bacterial Agents
Arthroplasty
Therapeutics
Pharmacokinetics
Vancomycin
Methicillin-Resistant Staphylococcus aureus
Serum

Keywords

  • infection
  • intraarticular antibiotics
  • MRSA
  • revision
  • total knee arthroplasty

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Intra-articular infusion : a direct approach to treatment of infected total knee arthroplasty. / Whiteside, L. A.; Roy, M. E.; Nayfeh, T. A.

In: Bone and Joint Journal, Vol. 98-B, No. 1, 01.01.2016, p. 31-36.

Research output: Contribution to journalArticle

Whiteside, L. A. ; Roy, M. E. ; Nayfeh, T. A. / Intra-articular infusion : a direct approach to treatment of infected total knee arthroplasty. In: Bone and Joint Journal. 2016 ; Vol. 98-B, No. 1. pp. 31-36.
@article{f2c06c8e6ffd41588c9d32f265d3b046,
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.",
keywords = "infection, intraarticular antibiotics, MRSA, revision, total knee arthroplasty",
author = "Whiteside, {L. A.} and Roy, {M. E.} and Nayfeh, {T. A.}",
year = "2016",
month = "1",
day = "1",
doi = "10.1302/0301-620X.98B.36276",
language = "English (US)",
volume = "98-B",
pages = "31--36",
journal = "Bone and Joint Journal",
issn = "2049-4394",
publisher = "British Editorial Society of Bone and Joint Surgery",
number = "1",

}

TY - JOUR

T1 - Intra-articular infusion

T2 - a direct approach to treatment of infected total knee arthroplasty

AU - Whiteside, L. A.

AU - Roy, M. E.

AU - Nayfeh, T. A.

PY - 2016/1/1

Y1 - 2016/1/1

N2 - 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.

AB - 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.

KW - infection

KW - intraarticular antibiotics

KW - MRSA

KW - revision

KW - total knee arthroplasty

UR - http://www.scopus.com/inward/record.url?scp=84973409656&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84973409656&partnerID=8YFLogxK

U2 - 10.1302/0301-620X.98B.36276

DO - 10.1302/0301-620X.98B.36276

M3 - Article

VL - 98-B

SP - 31

EP - 36

JO - Bone and Joint Journal

JF - Bone and Joint Journal

SN - 2049-4394

IS - 1

ER -