Regional prophylaxis with teicoplanin in monolateral or bilateral total knee replacement: an open study

From January 1991 to June 1997, patients undergoing primary elective monola teral or bilateral total knee replacement (TKR) were consecutively enrolled in a prospective, open clinical study on the efficacy and safety of region al prophylaxis with teicoplanin (TEC), Those scheduled for monolateral TKR (115 patients) received 400 mg of TEC in 100 mi of saline as a 5-min infusi on into a foot vein of the leg to be operated on immediately after the tour niquet was inflated to 400 mm Hg (ca, 50 kPa), For patients undergoing bila teral surgery (45 patients), regional administration of TEC was also repeat ed for the second knee operation. Follow-up ranged from a minimum of 2 year s to 8 years. None of the patients experienced local or systemic adverse ef fects following regional administration of TEC. In the immediate postoperat ive and 2-year follow-up periods, only one superficial infection of the pri mary site attributable to intraoperative contamination (prophylaxis failure ) out of the 205 prostheses implanted was observed. Deep infections involvi ng the prosthesis did not occur. Infectious complications at distant sites were observed in nine cases (urinary tract infection due to Escherichia col i in eight cases, and Salmonella enteritidis gastroenteritis in one case) i n the immediate postoperative period; they all were rapidly cured after ant ibiotic treatment. A delayed prosthetic infection, related to hematogenous spread of the etiological agent and therefore not considered a prophylactic failure, was observed in a patient who had undergone TKR 5 years before. R egional administration of TEC in monolateral and bilateral TKR appears to b e a safe and valuable prophylactic technique.