Orthopaedic Joint Infections: Intra-articular Antibiotics

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- Discussion: 
    - THR infections
    - TKR Infections
    - septic arthritis
    - specific organisms:
            - gram negative bacilli:
            - gram negative cocci:
            - gram positive bacilli:
            - gram positive cocci

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 - Technique and Dosing:
    - see: Use of Hickman Catheters for Intraarticular Administration of Antibiotics and blue journal article
    - surgical reimplantation is carried out in the usual manner;
    - hickman catheter is tunneled from the joint to the outer skin (catheter cuff is left just beneath the dermis);
    - the intra-articular dose of vancomycin is adjusted to meet optimal serum levels;
    - initial dose is 500 mg in 10 cc NS infused twice daily;
    - be aware that vancomycin can precipitate at high concentrations when mixed with small amounts of cephalosporins and clindamycin;

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 - References:

A simple method of intra-articular antibiotic delivery in infected hip arthroplasty.

Effects of continuous intra-articular infusion of gentamicin on synovial membrane and articular cartilage in the tarsocrural joint of horses.

Direct exchange treatment of septic total joint arthroplasty with intra-articular infusion of antibiotics: technique and early results.