This article is more than 5 years old. Information may no longer be current.

Direct antibiotic infusion can greatly simplify revision TKA and help enhance outcomes

Surgeons found they could combine surgical steps, avoid many wound complications and improve knee scores using intra-articular antibiotic infusion.

Add topic to email alerts

Receive an email when new articles are posted on

Please provide your email address to receive an email when new articles are posted on .

Subscribe

Added to email alerts

You've successfully added to your alerts. You will receive an email when new content is published.

Click Here to Manage Email Alerts

You've successfully added to your alerts. You will receive an email when new content is published.

Click Here to Manage Email Alerts

Back to Healio

We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com.

Back to Healio

ORLANDO, Fla. — Using direct antibiotic infusion when revising an infected total knee arthroplasty can eliminate one of the two separate surgical procedures typically required for effective revision procedure, according to a surgeon speaking here.

The direct fusion method delivers 500 to 1,000 times more antibiotic where the surgeon wants it compared to intravenous drip delivery or antibiotic-laced spacers, said Leo A. Whiteside, MD, of the Missouri Bone & Joint Center in St. Louis. He discussed using direct antibiotic infusion during revision total knee arthroplasty (TKA) at the Current Concepts in Joint Replacement Winter 2006 Meeting.

Whiteside said intra-articular antibiotic infusion, using two indwelling Hickman catheters, is often used in chemotherapy and should be adopted by orthopedic surgeons for antibiotic delivery in many revision cases.

"The idea of putting antibiotic directly at the site has been around for some time," Whiteside said. "This is infusing directly into the infected area, much as they do in chemotherapy."

In a retrospective study, Whiteside and colleagues treated two groups of infected TKA patients. For the first group, which included 31 knees, surgeons removed the components, debrided the joint and implanted new, cementless components without bone graft in a single procedure. They then placed indwelling Hickman catheters to deliver organism-specific antibiotics intra-articularly for 6 weeks.

The second group included 22 knees treated with a two-stage procedure. For these cases, surgeons performed debridement and inserted a spacer, followed by 6 weeks on intra-articular antibiotics administered through the Hickman catheters. They then performed revision arthroplasty using porous-coated implants.

The direct intra-articular antibiotic infusions eliminated the infection in both groups, but the researchers found significant differences in outcomes between the two approaches. Beyond streamlining the full treatment cycle from two to one procedure, investigators also found the following:

• Wound complications proved significantly more common (P=.02) in the two-stage group.
• The two-stage group had significantly more cardiovascular complications (P=.05).
• The one-stage group had significantly better knee scores at 2 years (P=.042).

"This is an alternative to using an [antibiotic-containing] cement spacer, [which] does not deliver that much antibiotic," Whiteside said. And using intravenous delivery channels, only 1 or 2 grams of antibiotic reaches the site over 6 weeks, while the direct infusion method delivers about 2 grams a day, Whiteside said.

All patients received organism-specific antibiotics.

For more information:

• Whiteside LA. Direct intra-articular infusion for infected joints. #117. Presented at the 23rd Annual Current Concepts in Joint Replacement Winter 2006 Meeting. Dec. 13-16, 2006. Orlando, Fla.