Acute Hematogenous and Synchronous Periprosthetic Joint Infection in Bilateral total Knee Arthroplasty: Successful Management with Dair, Intraosseous Vancomycin, and Antibiotic-Loaded Calcium Sulfate Beads

Introduction: Acute hematogenous periprosthetic joint infection (PJI) is rare, and synchronous bilateral presentation is exceedingly uncommon. Prompt and effective treatment is required to prevent implant failure.

Case Presentation: We report the case of a 68-year-old woman with a history of bilateral total knee arthroplasty who developed synchronous hematogenous PJI due to methicillin-resistant Staphylococcus aureus (MRSA). A bilateral DAIR procedure was performed in both knees with intraosseous vancomycin administration and antibiotic-loaded calcium sulfate beads.

Discussion: Combined use of intraosseous vancomycin and antibiotic-impregnated beads may enhance local antibiotic concentration in complex infections. This case illustrates successful infection control using an intensified local antimicrobial strategy.

Conclusion: In this case, synchronous acute periprosthetic joint infection was successfully treated using the DAIR procedure combined with intensified local antibiotic delivery strategies.

Keywords: Periprosthetic Joint Infection, DAIR, Synchronous Infection, Intraosseous Vancomycin, Calcium Sulfate Beads, Knee Arthroplasty.