Results of one-stage exchange arthroplasties in cases of periprosthetic infections with methicillin-resistant Staphylococcus aureus (MRSA)

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.