Skip to main content
SpringerLink
Log in

Prosthetic Retention: Treatment Options

  • Chapter
  • First Online:
Book cover Periprosthetic Joint Infection of the Hip and Knee

  • 1690 Accesses

Abstract

Infection after total joint arthroplasty (TJA) remains a difficult complication to treat. The rate of infection ranges from 0.5 to 4 % after primary and revision hip and knee arthroplasty. Several demographic studies indicate that more infections occur after these procedures and infection is the most common reason for TKA failure and third most common reason for THA failure. Prevention remains the key to minimizing the risk of infection; however, little evidence-based literature exists to establish the optimal approach.

Several options are available to treat deep periprosthetic infections. The timing of the infection as it relates to surgery and the onset of symptoms are critical in determining treatment success. Prosthetic retention is an attractive low-morbidity option for the treatment of the infected total TJA. Options include antibiotic suppression, arthroscopic irrigation and debridement and open irrigation and debridement with polyethylene exchange. The overall indications for prosthetic retention options are limited. The overall success as reported in more recent literature for any prosthetic retention options brings into question its current role in the treatment of the infected TJA.

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

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 179.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Bozic KJ, Kurtz SM, Lau E, Ong K, Vail TP, Berry DJ. The epidemiology of revision total hip arthroplasty in the United States. J Bone Joint Surg Am. 2009;91(1):128–33.

    Article  PubMed  Google Scholar 

  2. Kurtz SM, Lau E, Schmier J, Ong KL, Zhao K, Parvizi J. Infection burden for hip and knee arthroplasty in the United States. J Arthroplast. 2008;23(7):984–91.

    Article  Google Scholar 

  3. Bozic KJ, Kurtz SM, Lau E, et al. The epidemiology of revision total knee arthroplasty in the United States. Clin Orthop Relat Res. 2010;468(1):45–51.

    Article  PubMed  Google Scholar 

  4. Kurtz SM, Ong KL, Schmier J, et al. Future clinical and economic impact of revision total hip and knee arthroplasty. J Bone Joint Surg Am. 2007;89 Suppl 3:144–51.

    Article  PubMed  Google Scholar 

  5. Lavernia C, Lee DJ, Hernandez VH. The increasing financial burden of knee revision surgery in the United States. Clin Orthop Relat Res. 2006;446:221–6.

    Article  PubMed  Google Scholar 

  6. Tsukayama DT, Goldberg VM, Kyle R. Diagnosis and management of infection after total knee arthroplasty. J Bone Joint Surg Am. 2003;85-A Suppl 1:S75–80.

    PubMed  Google Scholar 

  7. Trampuz A, Hanssen AD, Osmon DR, Mandrekar J, Steckelberg JM, Patel R. Synovial fluid leukocyte count and differential for the diagnosis of prosthetic knee infection. Am J Med. 2004;117(8):556–62.

    Article  PubMed  Google Scholar 

  8. Rand JA, Morrey BF, Bryan RS. Management of the infected total joint arthroplasty. Orthop Clin N Am. 1984;15(3):491–504.

    CAS  Google Scholar 

  9. Rao N, Crossett LS, Sinha RK, Le Frock JL. Long-term suppression of infection in total joint arthroplasty. Clin Orthop Relat Res. 2003;414:55–60.

    Article  PubMed  Google Scholar 

  10. 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. Foreign-Body Infection (FBI) Study Group. JAMA. 1998;279(19):1537–41.

    Article  PubMed  CAS  Google Scholar 

  11. Toms AD, Davidson D, Masri BA, Duncan CP. The management of peri-prosthetic infection in total joint arthroplasty. J Bone Joint Surg Br. 2006;88(2):149–55.

    PubMed  CAS  Google Scholar 

  12. Waldman BJ, Hostin E, Mont MA, Hungerford DS. Infected total knee arthroplasty treated by arthroscopic irrigation and debridement. J Arthroplast. 2000;15(4):430–6.

    Article  CAS  Google Scholar 

  13. Dixon P, Parish EN, Cross MJ. Arthroscopic debridement in the treatment of the infected total knee replacement. J Bone Joint Surg Br. 2004;86(1):39–42.

    PubMed  CAS  Google Scholar 

  14. 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(9):1383–90.

    PubMed  CAS  Google Scholar 

  15. Rasul Jr 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 

  16. Hooper GJ, Rothwell AG, Frampton C, Wyatt MC. Does the use of laminar flow and space suits reduce early deep infection after total hip and knee replacement? The ten-year results of the New Zealand joint registry. J Bone Joint Surg Br. 2011;93B(1):85–90.

    Google Scholar 

  17. Miner AL, Losina E, Katz JN, Fossel AH, Platt R. Deep infection after total knee replacement: impact of laminar airflow systems and body exhaust suits in the modern operating room. Infect Contr Hosp Epidemiol. 2007;28(2):222–6.

    Article  Google Scholar 

  18. Spangehl MJ, Masterson E, Masri BA, O’Connell JX, Duncan CP. The role of intraoperative gram stain in the diagnosis of infection during revision total hip arthroplasty. J Arthroplast. 1999;14(8):952–6.

    Article  CAS  Google Scholar 

  19. Feldman DS, Lonner JH, Desai P, Zuckerman JD. The role of intraoperative frozen sections in revision total joint arthroplasty. J Bone Joint Surg Am. 1995;77(12):1807–13.

    PubMed  CAS  Google Scholar 

  20. Musso AD, Mohanty K, Spencer-Jones R. Role of frozen section histology in diagnosis of infection during revision arthroplasty. Postgrad Med J. 2003;79(936):590–3.

    Article  PubMed  CAS  Google Scholar 

  21. 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(7):1415–22.

    Article  PubMed  Google Scholar 

  22. Dirschl DR, Wilson FC. Topical antibiotic irrigation in the prophylaxis of operative wound infections in orthopedic surgery. Orthop Clin North Am. 1991;22(3):419–26.

    PubMed  CAS  Google Scholar 

  23. Roth RM, Gleckman RA, Gantz NM, Kelly N. Antibiotic irrigations. A plea for controlled clinical trials. Pharmacotherapy. 1985;5(4):222–7.

    PubMed  CAS  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;404:125–31.

    Article  PubMed  Google Scholar 

  25. Brandt CM, Sistrunk WW, Duffy MC, et al. Staphylococcus aureus prosthetic joint infection treated with debridement and prosthesis retention. Clin Infect Dis. 1997;24(5):914–9.

    Article  PubMed  CAS  Google Scholar 

  26. Marculescu CE, Berbari EF, Hanssen AD, et al. Outcome of prosthetic joint infections treated with debridement and retention of components. Clin Infect Dis. 2006;42(4):471–8.

    Article  PubMed  CAS  Google Scholar 

  27. Hsieh P-H, Lee MS, Hsu K-Y, Chang Y-H, Shih H-N, Ueng SW. Gram-negative prosthetic joint infections: risk factors and outcome of treatment. Clin Infect Dis. 2009;49(7):1036–43.

    Article  PubMed  Google Scholar 

  28. Mont MA, Waldman B, Banerjee C, Pacheco IH, Hungerford DS. Multiple irrigation, debridement, and retention of components in infected total knee arthroplasty. J Arthroplast. 1997;12(4):426–33.

    Article  CAS  Google Scholar 

  29. Vilchez F, Martinez-Pastor JC, Garcia-Ramiro S, et al. Outcome and predictors of treatment failure in early post-surgical prosthetic joint infections due to Staphylococcus aureus treated with debridement. Clin Microbiol Infect. 2011;17(3):439–44.

    Article  PubMed  CAS  Google Scholar 

  30. Theis J-C, Gambhir S, White J. Factors affecting implant retention in infected joint replacements. ANZ J Surg. 2007;77(10):877–9.

    Article  PubMed  Google Scholar 

  31. Peersman G, Laskin R, Davis J, Peterson MGE, Richart T. ASA physical status classification is not a good predictor of infection for total knee replacement and is influenced by the presence of comorbidities. Acta Orthopaedica Belgica. 2008;74(3):360–4.

    PubMed  Google Scholar 

  32. Berbari EF, Osmon DR, Duffy MCT, et al. Outcome of prosthetic joint infection in patients with rheumatoid arthritis: the impact of medical and surgical therapy in 200 episodes. Clin Infect Dis. 2006;42(2):216–23.

    Article  PubMed  Google Scholar 

  33. Betsch BY, Eggli S, Siebenrock KA, Tauber MG, Muhlemann K. Treatment of joint prosthesis infection in accordance with current recommendations improves outcome. Clin Infect Dis. 2008;46(8):1221–6.

    Article  PubMed  Google Scholar 

  34. Parvizi J, Azzam K, Ghanem E, Austin MS, Rothman RH. Periprosthetic infection due to resistant staphylococci: serious problems on the horizon. Clin Orthop Relat Res. 2009;467(7):1732–9.

    Article  PubMed  Google Scholar 

  35. Parvizi J, Bender B, Saleh KJ, Brown TE, Schmalzried TP, Mihalko WM. Resistant organisms in infected total knee arthroplasty: occurrence, prevention, and treatment regimens. Instr Course Lect. 2009;58:271–8.

    PubMed  Google Scholar 

  36. Brown WJ. Microbiology of the infected total joint arthroplasty. Semin Arthroplast. 1994;5(3):107–13.

    CAS  Google Scholar 

  37. Garvin KL, Hinrichs SH, Urban JA. Emerging antibiotic-resistant bacteria. Their treatment in total joint arthroplasty. Clin Orthop Relat Res. 1999;369:110–23.

    Article  PubMed  Google Scholar 

  38. Deirmengian C, Greenbaum J, Lotke PA, Booth Jr 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 Arthroplast. 2003;18(7 Suppl 1):22–6.

    Article  Google Scholar 

  39. Bradbury T, Fehring TK, Taunton M, et al. The fate of acute methicillin-resistant Staphylococcus aureus periprosthetic knee infections treated by open debridement and retention of components. J Arthroplast. 2009;24(6 Suppl):101–4.

    Article  Google Scholar 

  40. Odum SM, Fehring TK, Lombardi AV, et al. Irrigation and debridement for periprosthetic infections: does the organism matter? J Arthroplasty. 2011;26(6 Suppl):114–8.

    Article  PubMed  Google Scholar 

  41. Zmistowski B, Fedorka CJ, Sheehan E, Deirmengian G, Austin MS, Parvizi J. Prosthetic joint infection caused by gram-negative organisms. J Arthroplast. 2011;26(6):104–8.

    Article  Google Scholar 

  42. 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(4):512–23.

    PubMed  CAS  Google Scholar 

  43. Sukeik M, Patel S, Haddad F. Aggressive early débridement for treatment of acutely infected cemented total hip arthroplasty. Clin Orthop Relat Res. 2012;470(11):3164–70.

    Article  PubMed  Google Scholar 

  44. Lhotellier L (2002) Infections precoces dorigine operatoire, resultats et indication des nettoyages associes a une antibiotherapie. Symposium Sofcot 2001. Rev Chir Orthop. Suppl5:5166–8.

    Google Scholar 

  45. Klouche S, Lhotellier L, et al. Infected total hip arthroplasty treated by an irrigation-debridement/component rentention protocol. A prospective study in a 12-case series with minimum 2 years’ follow-up. Orthop Traumatol Surg Res. 2011;97(2):134–8.

    Article  PubMed  CAS  Google Scholar 

  46. 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(9):1306–13.

    PubMed  CAS  Google Scholar 

  47. Meehan AM, Osmon DR, Duffy MC, 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(7):845–9.

    Article  PubMed  CAS  Google Scholar 

  48. Estes CS, Beauchamp CP, Clarke HD, Spangehl MJ. A two-stage retention debridement protocol for acute periprosthetic joint infections. Clin Orthop Relat Res. 2010;468(8):2029–38.

    Article  PubMed  Google Scholar 

  49. Koyonos L, Zmistowski B, Della Valle CJ, Parvizi J. Infection control rate of irrigation and debridement for periprosthetic joint infection. Clin Orthop Relat Res. 2011;469(11):3043–8.

    Article  PubMed  Google Scholar 

  50. Choi H-R, von Knoch F, Zurakowski D, Nelson SB, Malchau H. Can implant retention be recommended for treatment of infected TKA? Clin Orthop Relat Res. 2011;469(4):961–9.

    Article  PubMed  Google Scholar 

  51. Azzam KA, Seeley M, Ghanem E, Austin MS, Purtill JJ, Parvizi J. Irrigation and debridement in the management of prosthetic joint infection: traditional indications revisited. J Arthroplast. 2010;25(7):1022–7.

    Article  Google Scholar 

  52. Salgado CD, Dash S, Cantey JR, Marculescu CE. Higher risk of failure of methicillin-resistant Staphylococcus aureus prosthetic joint infections. Clin Orthop Relat Res. 2007;461:48–53.

    PubMed  Google Scholar 

  53. Deirmengian C, Greenbaum J, Stern J, et al. Open debridement of acute gram-positive infections after total knee arthroplasty. Clin Orthop Relat Res. 2003;416:129–34.

    Article  PubMed  Google Scholar 

  54. Segawa H, Tsukayama DT, 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(10):1434–45.

    PubMed  CAS  Google Scholar 

  55. Wasielewski RC, Barden RM, Rosenberg AG. Results of different surgical procedures on total knee arthroplasty infections. J Arthroplast. 1996;11(8):931–8.

    Article  CAS  Google Scholar 

  56. Kramhoft M, Bodtker S, Carlsen A. Outcome of infected total knee arthroplasty. J Arthroplast. 1994;9(6):617–21.

    Article  CAS  Google Scholar 

  57. 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(1):35–9.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Ortho Carolina, 2001 Vail Avenue, Charlotte, NC, 28207, USA

    David N. Vegari M.D

  2. OrthoCarolina Hip and Knee Center, 2001 Vail Avenue, Charlotte, NC, 28207, USA

    Bryan D. Springer M.D

Authors
  1. David N. Vegari M.D
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bryan D. Springer M.D
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bryan D. Springer M.D .

Editor information

Editors and Affiliations

  1. OrthoCarolina Hip and Knee Center, Charlotte, North Carolina, USA

    Bryan D. Springer

  2. Rothman Institute of Orthopedics, Philadelphia, Pennsylvania, USA

    Javad Parvizi

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer Science+Business Media New York

About this chapter

Cite this chapter

Vegari, D.N., Springer, B.D. (2014). Prosthetic Retention: Treatment Options. In: Springer, B., Parvizi, J. (eds) Periprosthetic Joint Infection of the Hip and Knee. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-7928-4_11

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-7928-4_11

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-7927-7

  • Online ISBN: 978-1-4614-7928-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation