In this literature review, 30 reports provided outcome data on 37 direct exchange
arthroplasties, 530 open
debridements, and 23 arthroscopic
debridements. The average followup was approximately 4 years, but the range was broad (range, 0.02-14 years).
Infection was controlled in 33 of the 37 infected total knee
arthroplasties (89.2%) treated by direct exchange
arthroplasty, in only 173 of the 530 infected total knee
arthroplasties (32.6%) treated by open
debridement and retention of the prosthetic components, and in 12 of the 23 infected total knee
arthroplasties (52.2%) treated by arthroscopic
debridement. There was wide variability in associated
antibiotic therapy. Factors associated with successful direct exchange included
infections by gram-positive organisms, absence of sinus formation, use of
antibiotic-impregnated
bone cement for the new
prosthesis, and 12 weeks of
antibiotic therapy. Direct exchange
arthroplasty failed in four of 37 knees; two were in patients with
rheumatoid arthritis who were taking
corticosteroids. Factors associated with successful
debridements included those done within 4 months of the index procedure, or in patients with less than 4 weeks of symptoms,
antibiotic sensitive gram-positive organisms, well-fixed components with no radiologic evidence of
osteitis, and in young healthy patients. Factors associated with the failed
debridements included postoperative drainage for more than 2 weeks, sinus tracts present at the time of the
debridement, a hinged
prosthesis, and an immunocompromised host. Direct exchange can be successful with a sensitive organism in a healthy host with prolonged
antibiotic therapy.
Debridement can be successful in early
infections in a healthy host.