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Irrigation and Débridement and Prosthesis Retention for Treating Acute Periprosthetic Infections

  • Symposium: Papers Presented at the 2009 Meeting of the Musculoskeletal Infection Society
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Infections following hip and knee replacements can compromise the function and durability of arthroplasty. When these infections occur during the immediate postoperative period, irrigation and débridement can be attempted to salvage the implant. Prior studies have reported varying results likely due to lack of consistent inclusion criteria, variations in surgical technique, and lack of uniform treatment protocols.

Questions/purposes

To supplement this literature we determined the rate at which irrigation and débridement and prosthesis retention would control acute periprosthetic infections.

Methods

We retrospectively reviewed the medical records of 18 patients with acute periprosthetic infections occurring within 28 days after 13 THAs and 5 TKAs. The mean time to reoperation was 19 days (range, 6–28 days) after arthroplasty. Superficial débridements were performed in five cases, and a polyethylene or ball head exchange was performed in the remaining 13 cases when fascial defects were encountered at the time of surgery.

Results

We salvaged the prosthesis in four of five patients with superficial irrigation and débridement group and eight of 13 with deep infections. Intraoperative cultures were positive in 83% of cases (n = 15). Five patients (one superficial and four deep) eventually underwent resection arthroplasty. Three patients underwent repeat irrigation and débridement, and one of these three ultimately had resection arthroplasty. Polymicrobial infections were detected in four cases, all failures. The average time to resection was 62 days (range, 12–134 days).

Conclusions

Consistent with the literature, success of prosthesis salvage for periprosthetic infections occurring within 28 days after arthroplasty depends on the location, extent, and microbiology of the infection.

Level of Evidence

Level IV, case series. See the Guidelines for Authors for a complete description of levels of evidence.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Pennsylvania Health System, Penn-Presbyterian Medical Center, 1 Cupp Pavilion, 39th and Market Streets, Philadelphia, PA, 19104, USA

    Jonathan P. Van Kleunen MD, Denise Knox BS, Jonathan P. Garino MD & Gwo-Chin Lee MD

Authors
  1. Jonathan P. Van Kleunen MD
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  2. Denise Knox BS
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  3. Jonathan P. Garino MD
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  4. Gwo-Chin Lee MD
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Corresponding author

Correspondence to Gwo-Chin Lee MD.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Van Kleunen, J.P., Knox, D., Garino, J.P. et al. Irrigation and Débridement and Prosthesis Retention for Treating Acute Periprosthetic Infections. Clin Orthop Relat Res 468, 2024–2028 (2010). https://doi.org/10.1007/s11999-010-1291-y

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  • DOI: https://doi.org/10.1007/s11999-010-1291-y

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