Bacterial infection is a serious complication after joint replacement surgery. In particular, methicillin-resistant Staphylococcus aureus (MRSA) and epidermidis(MRSE) are very difficult to eradicate in infected prosthetic joint. Therefore, the retention rate of initial prosthesis affected with such resistant microorganisms is still low. Gentian violet shows potent antibacterial activity against gram-positive cocci as minimal bactericidal concentration is less than 0.1 %. In the present study, we investigated the efficacy of treatment with gentian violet against MRSA and MRSE infections after THA, TKA, and bipolar hip hemiarthroplasty (BHP). There were 8 patients in this study; five patients with deep periprosthetic MRSA infection (2 THA, 2 BHP, 1 revision TKA); 3 patients with MRSE infection (1 revision THA, 1 BHP, 1 TKA). When infection was suspected after the surgery, we quickly obtained synovial fluid and periprosthetic soft tissue from the joint and applied to culture and microscopic examinations for detection of microorganisms. After identification of bacterial species, we immediately debrided the affected joint and washed thoroughly twice with 0.1% solution of gentian violet for 3 minutes each, followed by intra-articular multiple injection of arbekacin sulfate solution. Then we inserted an aspiration tube into the joint and administered appropriate antibiotics intravenously. If the inflammatory symptoms persisted in spite of the first treatment, we repeated the treatment until inflammation signs and intra-articular microorganisms could not be detected.Objective
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