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Orthopaedic Joint Infections: Intra-articular Antibiotics


- Discussion: 
    - properties of antibiotics to cementproperties of vancomycin in cement
    - THR infections / - TKR Infections
    - septic arthritis
    - specific organisms:
            - gram negative bacilli: - gram negative cocci: - gram positive bacilli: - gram positive cocci


 - Technique and Dosing:
    - 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;

- human papers:
           - A simple method of intra-articular antibiotic delivery in infected hip arthroplasty.
           - Direct exchange treatment of septic total joint arthroplasty with intra-articular infusion of antibiotics: technique and early results.
           - Methicillin-resistant Staphylococcus aureus in TKA treated with revision and direct intra-articular antibiotic infusion.
           - Use of Hickman Catheters for Intraarticular Administration of Antibiotics
           - Methicillin-resistant Staphylococcus aureus in TKA Treated With Revision and Direct Intraarticular Antibiotic Infusion 
           - Two-Stage Exchange for Infected TKA—Opposes
           - High-dose antibiotic infusion for infected knee prosthesis without implant removal 
           -
Reinfected Revised TKA Resolves With an Aggressive Protocol and Antibiotic Infusion 

    - animal papers: 
           - Intra-articular administration of doxycycline in calves
           - Comparison of intraosseous or intravenous infusion for delivery of amikacin sulfate to the tibiotarsal joint of horses
           - How to Treat Septic Joints with Constant Intra-articular Infusion of Gentamicin or Amikacin
           - Effects of continuous intra-articular infusion of gentamicin on synovial membrane and articular cartilage in the tarsocrural joint of horses.
           - Septic Joint Treatment with Constant Intra-articular Infusion of Gentamicin or Amikacin



The management of chronic osteomyelitis using the Lautenbach method