Irrigation, Débridement, and Implant Retention for Recurrence of Periprosthetic Joint Infection Following Two-Stage Revision Total Knee Arthroplasty: A Matched Cohort Study.

Abstract

BACKGROUND:

We investigated clinical/functional outcomes and implant survivorship in patients who underwent 2-stage revision total knee arthroplasty (TKA) after periprosthetic joint infection (PJI), experienced acute PJI recurrence, and underwent irrigation, débridement, and polyethylene exchange (IDPE) with retention of stable implant.

METHODS:

Twenty-four patients (24 knees) were identified who underwent 2-stage revision TKA for PJI, experienced acute PJI recurrence, and then underwent IDPE between 2005 and 2016 (minimum 2-year follow-up). After IDPE, intravenous antibiotics (6 weeks) and oral suppression therapy (minimum 6 months) were administered. Data were compared with 1:2 matched control group that underwent 2-stage revision TKA for chronic PJI and did not receive IDPE.

RESULTS:

Average IDPE group follow-up was 3.8 years (range, 2.4-7.2). Reinfection rate after IDPE was 29% (n = 7): 3 of 7 underwent second IDPE (2 of 3 had no infection recurrence) and 5 (one was patient who had recurrent infection after second IDPE) underwent another 2-stage revision TKA. Control group reinfection rate was 27% (n = 13) (P = .85). For IDPE group, mean time to reinfection after 2-stage revision TKA was 4.6 months (range, 1-8 months) (patients presented with acute symptoms less than 3 weeks duration). At latest follow-up, mean Knee Society Score was 70 (range, 35-85) in IDPE group and 75 (range, 30-85) in control group (P = .53).

CONCLUSION:

IDPE for acute reinfection following 2-stage revision TKA with well-fixed implants had a 71% success rate. These patients had comparable functional outcome as patients with no IDPE after 2-stage revision TKA. IDPE followed by long-term suppression antibiotic therapy should be considered in patients with acute infection and stable components.

• Authors: Hamed Vahedi, Arash Aali-Rezaie, Alisina Shahi, Janet D Conway
• Journal: The Journal of arthroplasty (J Arthroplasty) Vol. 34 Issue 8 Pg. 1772-1775 (Aug 2019) ISSN: 1532-8406 [Electronic] United States
• PMID: 31060919 (Publication Type: Journal Article)
• Copyright: Copyright © 2019 Elsevier Inc. All rights reserved.

Chemical References

• Anti-Bacterial Agents
• Polyethylene

Topics

• Adult
• Aged
• Anti-Bacterial Agents (administration & dosage)
• Arthritis, Infectious (etiology)
• Arthroplasty, Replacement, Knee (adverse effects)
• Debridement
• Female
• Follow-Up Studies
• Humans
• Knee Joint (surgery)
• Male
• Middle Aged
• Muscle, Skeletal (surgery)
• Polyethylene
• Prosthesis Failure
• Prosthesis-Related Infections (prevention & control, surgery)
• Recurrence
• Retrospective Studies
• Therapeutic Irrigation
• Treatment Outcome