Orthopaedic Joint Infections: Intra-articular Antibiotics : Wheeless' Textbook of Orthopaedics

- Discussion:
    - properties of antibiotics to cement / properties 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