J. Kordelle et al., Results of one-stage exchange arthroplasties in cases of periprosthetic infections with methicillin-resistant Staphylococcus aureus (MRSA), Z ORTHOP GR, 138(3), 2000, pp. 240-244
Objective: Are the results of one-stage exchange arthroplasties to treat pe
riprosthetic infection caused by methicillin-resistant Staphylococcus aureu
s (MRSA) comparable to bacteriologically unselected studies of one-stage ex
change operations? Method: From 1996 to 1997 twenty patients with a peripro
sthetic infection caused by methicillin-resistant Staphylococcus aureus (MR
SA) were treated at the ENDO-klinik by an one-stage exchange arthroplasty.
Mean follow-up of fifteen one-stage exchange total hip replacements and 5 o
ne-stage exchange total knee replacements was 16 months. The patients were
examined by means of clinical, laboratory-chemical and radiological tests.
In addition, postoperative joint aspiration was performed on 14 patients. R
esults: In 11 cases (61 %) the periprosthetic infection was treated success
fully with only one one-stage exchange operation. In cases with persisting
infection the period between the first exchange arthroplasty and the repeat
ed clinical manifestation of the infection (second exchange operation) was
2 months on average. 93 % of the joint aspirations (n = 14), performed on a
verage 4 weeks postoperatively, correlated with the result of the follow-up
tests. Conclusion: Periprosthetic infection with MRSA is a problematic inf
ection. Because of the reduced therapeutic possibilities it is associated w
ith a higher rate of recurrence than the unselected group of patients as a
whole [6,11,16,17,19,20]. The authors recommend one-stage exchange arthropl
asty using a combination of vancomycin and ofloxacin as admixture to polyme
thylmethacrylat (Refobacin Palacos(R) R). This procedere does, however, nee
d further development. Intraoperative use of an antiseptic and systemic adm
inistration of rifampicin, as recommended by Zimmerli [23] is a further pos
sibility.