Acute Hematogenous and Synchronous Periprosthetic Joint Infection in Bilateral total Knee Arthroplasty: Successful Management with Dair, Intraosseous Vancomycin, and Antibiotic-Loaded Calcium Sulfate Beads
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Published: 7 July 2025 | Article Type : Case ReportAbstract
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.

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Walter F. Martínez, Eduardo J. Bochatey, Fernando A. Lopreite. (2025-07-07). "Acute Hematogenous and Synchronous Periprosthetic Joint Infection in Bilateral total Knee Arthroplasty: Successful Management with Dair, Intraosseous Vancomycin, and Antibiotic-Loaded Calcium Sulfate Beads." *Volume 6*, 1, 20-24