Skip to main content

Advertisement

SpringerLink
Log in

A Two-stage Retention Débridement Protocol for Acute Periprosthetic Joint Infections

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

Abstract

Background

Due to the historically poor infection control rates with débridement and component retention for acute periprosthetic infections we developed a new approach for treating acute periprosthetic total joint infections: initial débridement with prosthesis retention and placement of antibiotic-impregnated cement beads followed by a second débridement within 7 days, at which time the beads are removed and new modular parts inserted. Intravenous antibiotics were used for 6 weeks followed by oral antibiotics. Depending on the clinical situation, antibiotics are discontinued or in selected patients continued indefinitely.

Questions/purposes

We determined the ability of this two-stage débridement to control infection.

Methods

We retrospectively reviewed the charts of 20 patients who underwent this technique; 2 had postoperative and 18 had hematogenous infections. The primary outcome measure was the infection control. The minimum followup was 1 year (mean, 3.5 years; range, 1.2–7.5 years).

Results

Two of the 20 patients had persistent infection. There were no failures in the acute postoperative group (0 of 2) and two of 18 in the acute hematogenous group. Of the 18 patients without evidence of persistent infection, 10 were no longer on antibiotics at the most recent followup and eight were treated with long-term antibiotics due to compromised host status.

Conclusions

The control of infection in 18 of 20 patients using this technique compares favorably with historical success rates, which range from 24% to 100%. Further research is required to analyze the individual contribution of débridement technique, the use of serial débridements, local depot antibiotics, and combination antibiotic therapy on short-term infection control rates and the long-term persistent control of periprosthetic infection.

Level of Evidence

Level IV, therapeutic study. See the Guidelines for Authors for a complete description of level of evidence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Adams K, Couch L, Cierny G, Calhoun J, Mader JT. In vitro and in vivo evaluation of antibiotic diffusion from antibiotic-impregnated polymethylmethacrylate beads. Clin Orthop Relat Res. 1992;278:244–252.

    PubMed  Google Scholar 

  2. Anglen JO. Comparison of soap and antibiotic solutions for irrigation of lower-limb open fracture wounds. A prospective, randomized study. J Bone Joint Surg Am. 2005;87:1415–1422.

    Article  PubMed  Google Scholar 

  3. Burger RR, Basch T, Hopson CN. Implant salvage in infected total knee arthroplasty. Clin Orthop Relat Res. 1991;273:105–112.

    PubMed  Google Scholar 

  4. Chiu F, Chen C. Surgical debridement and parenteral antibiotics in infected revision total knee arthroplasty. Clin Orthop Relat Res. 2007;461:130–135.

    PubMed  Google Scholar 

  5. Cierny G, DiPasquale D. Periprosthetic total joint infections: staging, treatment, and outcomes. Clin Orthop Rel Res. 2002;403:23–28.

    Article  Google Scholar 

  6. Cierny GI, Mader JT, Penninck JJ. A clinical staging system for adult osteomyelitis. Contemp Orthop. 1985;109:17–37.

    Google Scholar 

  7. Coventry MB, Beckenbaugh RD, Nolan DR, Ilstrup DM. 2,012 Total hip arthroplasties: A study of postoperative course and early complications. J Bone Joint Surg Am. 1974;56:273–284.

    CAS  PubMed  Google Scholar 

  8. Crockarell JR, Hanssen AD, Osmon DR, Morrey BF. Treatment of infection with debridement and retention of the components following hip arthroplasty. J Bone Joint Surg Am. 1998;80:1306–1313.

    CAS  PubMed  Google Scholar 

  9. Deirmengian C, Greenbaum J, Lotke PA, Booth RE, Lonner JH. Limited success with open debridement and retention of components in the treatment of acute Staphylococcus aureus infections after total knee arthroplasty. J Arthroplasty. 2003;18:22–26.

    Article  PubMed  Google Scholar 

  10. Ghanem E, Parvizi J, Burnett RSJ, Sharkey PF, Keshavarzi N, Aggarwal A, Barrack RL. Cell count and differential of aspirated fluid in the diagnosis of infection at the site of total knee arthroplasty. J Bone Joint Surg Am. 2008;90:1637–1643.

    Article  PubMed  Google Scholar 

  11. Hartman MB, Fehring TK, Jordan L, Norton HJ. Periprosthetic knee sepsis. The role of irrigation and debridement. Clin Orthop Relat Res. 1991;273:113–118.

    PubMed  Google Scholar 

  12. Ilahi OA, Al-Habbal GA, Bocell JR, Tullos HS, Huo MH. Arthroscopic debridement of acute periprosthetic septic arthritis of the knee. Arthroscopy. 2005;21:303–306.

    Article  PubMed  Google Scholar 

  13. Laffer RR, Graber P, Ochsner PE, Zimmerli W. Outcome of prosthetic knee-associated infection: Evaluation of 40 consecutive episodes at a single centre. Clin Mirobiol Infect. 2006;12:433–439.

    Article  CAS  Google Scholar 

  14. McLaren AC, Spooner CE. Salvage of infected total knee components. Clin Orthop Relat Res. 1996;331:146–150.

    Article  PubMed  Google Scholar 

  15. McPherson EJ, Tontz W, Patzakis M, Woodsome C, Holtom P, Norris L, Shufelt C. Outcome of infected total knee utilizing a staging system for prosthetic joint infection. Am J. Orthop. 1999;28:161–165.

    CAS  PubMed  Google Scholar 

  16. McPherson EJ, Woodson C, Holtom P, Roidis N, Shufelt C, Patzakis M. Periprosthetic total hip infection: outcomes using a staging system. Clin Orthop Relat Res. 2002;403:8–15.

    Article  PubMed  Google Scholar 

  17. Meehan AM, Osmon DR, Duffy MCT, Hanssen AD, Keating MR. Outcome of penicillin-susceptible streptococcal prosthetic joint infection treated with debridement and retention of the prosthesis. Clin Infect Dis. 2003;36:845–849.

    Article  CAS  PubMed  Google Scholar 

  18. Mirra JM, Amstutz HC, Matos M, Gold R. The pathology of the joint tissues and its clinical relevance in prosthesis failure. Clin Orthop Relat Res. 1976;117:221–240.

    PubMed  Google Scholar 

  19. Mont MA, Waldman B, Banerjee C, Pacheco IH, Hungerford DS. Multiple irrigation, debridement, and retention of components in infected total knee arthroplasty. J Arthroplasty. 1997;12:426–433.

    Article  CAS  PubMed  Google Scholar 

  20. Parvizi J, Ghanem E, Sharkey P, Aggarwal A, Burnett RS, Barrack RL. Diagnosis of infected total knee: Findings of a multicenter database. Clin Orthop Relat Res. 2008;466:2628–2633.

    Article  PubMed  Google Scholar 

  21. Rasul AT, Tsukayama D, Gustilo RB. Effect of time of onset and depth of infection on the outcome of total knee arthroplasty infections. Clin Orthop Relat Res. 1991;273:98–104.

    PubMed  Google Scholar 

  22. Schoifet SD, Morrey BF. Treatment of infection after total knee arthroplasty by debridement with retention of the components. J Bone Joint Surg Am. 1990;72:1383–1390.

    CAS  PubMed  Google Scholar 

  23. Segawa H, Tsukayama D, Kyle RF, Becker DA, Gustilo RB. Infection after total knee arthroplasty. A retrospective study of the treatment of eighty-one infections. J Bone Joint Surg Am. 1999;81:1434–1445.

    CAS  PubMed  Google Scholar 

  24. Silva M, Tharani R, Schmalzried TP. Results of direct exchange or debridement of the infected total knee arthroplasty. Clin Orthop Relat Res. 2002;404:125–131.

    Article  PubMed  Google Scholar 

  25. Spangehl MJ, Masri BA, O’Connell JX, Duncan CP. Prospective analysis of preoperative and intraoperative investigations for the diagnosis of infection at the sites of two hundred and two revision total hip arthroplasties. J Bone Joint Surg Am. 1999;81:672–683.

    CAS  PubMed  Google Scholar 

  26. Teeny SM, Dorr L, Murata G, Conaty P. Treatment of infected total knee arthroplasty. Irrigation and debridement versus two-stage reimplantation. J Arthroplasty. 1990;5:35–39.

    Article  CAS  PubMed  Google Scholar 

  27. Tsukayama DT, Estrada R, Gustilo RB. Infection after total hip arthroplasty. A study of the treatment of one hundred and six infections. J Bone Joint Surg Am. 1996;78:512–523.

    CAS  PubMed  Google Scholar 

  28. Wasielewski RC, Barden RM, Rosenberg AG. Results of different surgical procedures on total knee arthroplasty infections. J Arthroplasty. 1996;11:931–938.

    Article  CAS  PubMed  Google Scholar 

  29. Zimmerli W, Widmer AF, Blatter M, Frei R, Ochsner PE. Role of rifampin for treatment of orthopedic implant-related Staphylococcal infections. A randomized controlled trial. J Am Med Assoc. 1998;279:1537–1541.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Banner Good Samaritan Orthopaedic Residency Program, Phoenix, AZ, USA

    Chris S. Estes DO

  2. Mayo Clinic Arizona, 5777 East Mayo Blvd, Phoenix, AZ, 85054, USA

    Chris S. Estes DO, Chris P. Beauchamp MD, Henry D. Clarke MD & Mark J. Spangehl MD

Authors
  1. Chris S. Estes DO
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chris P. Beauchamp MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Henry D. Clarke MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mark J. Spangehl MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mark J. Spangehl MD.

Additional information

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.

This work was performed at the Mayo Clinic Arizona.

About this article

Cite this article

Estes, C.S., Beauchamp, C.P., Clarke, H.D. et al. A Two-stage Retention Débridement Protocol for Acute Periprosthetic Joint Infections. Clin Orthop Relat Res 468, 2029–2038 (2010). https://doi.org/10.1007/s11999-010-1293-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-010-1293-9

Keywords

Search

Navigation