Skip to main content
SpringerLink
Log in

Open debridement and prosthesis retention is a viable treatment option for acute periprosthetic joint infection after total knee arthroplasty

  • Knee Revision Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Purpose

Open debridement with prosthesis retention (ODPR) has been considered as a reasonable treatment option for acute periprosthetic joint infection (PJI) following total knee arthroplasty (TKA). However, multiple recent studies have challenged this contention. This study was undertaken to determine the success rate of ODPR, whether the success rate was affected by the ODPR timing or by the microorganisms.

Method

We retrospectively reviewed 52 cases of ODPR performed in four institutions to treat acute PJI which met the definition of PJI by the International Consensus Group on PJI. We recorded patient demographics; time from index TKA and symptom duration; the microorganisms involved; and whether the infection was controlled or not.

Results

The overall success rate of ODPR was 71 %, and early postoperative infection and acute hematogenous infection had a success rate of 82 and 55 %, respectively. Success rate was associated with a shorter symptom duration in patients with acute hematogenous infections (p = 0.040). However, success was not influenced by the type (p = 0.992) or virulence of the causative microorganisms (p = 0.706).

Conclusion

ODPR should be considered as a viable treatment option for acute PJI following TKA. The promptness of ODPR is of paramount importance for success of ODPR, rather than the causative organism type or virulence.

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. Aboltins CA, Page MA, Buising KL, Jenney AW, Daffy JR, Choong PF et al (2007) Treatment of staphylococcal prosthetic joint infections with debridement, prosthesis retention and oral rifampicin and fusidic acid. Clin Microbiol Infect 13(6):586–591

    Article  CAS  PubMed  Google Scholar 

  2. Azzam KA, Seeley M, Ghanem E, Austin MS, Purtill JJ, Parvizi J (2010) Irrigation and debridement in the management of prosthetic joint infection: traditional indications revisited. J Arthroplasty 25(7):1022–1027

    Article  PubMed  Google Scholar 

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

    Article  PubMed  PubMed Central  Google Scholar 

  4. Bradbury T, Fehring TK, Taunton M, Hanssen A, Azzam K, Parvizi J et al (2009) The fate of acute methicillin-resistant Staphylococcus aureus periprosthetic knee infections treated by open debridement and retention of components. J Arthroplasty 24(6 Suppl):101–104

    Article  PubMed  Google Scholar 

  5. Brandt CM, Sistrunk WW, Duffy MC, Hanssen AD, Steckelberg JM, Ilstrup DM et al (1997) Staphylococcus aureus prosthetic joint infection treated with debridement and prosthesis retention. Clin Infect Dis 24(5):914–919

    Article  CAS  PubMed  Google Scholar 

  6. Chiu FY, Chen CM (2007) Surgical debridement and parenteral antibiotics in infected revision total knee arthroplasty. Clin Orthop Relat Res 461:130–135

    PubMed  Google Scholar 

  7. Choi HR, von Knoch F, Zurakowski D, Nelson SB, Malchau H (2011) Can implant retention be recommended for treatment of infected TKA? Clin Orthop Relat Res 469(4):961–969

    Article  PubMed  PubMed Central  Google Scholar 

  8. Deirmengian C, Greenbaum J, Lotke PA, Booth RE Jr, Lonner JH (2003) Limited success with open debridement and retention of components in the treatment of acute Staphylococcus aureus infections after total knee arthroplasty. J Arthroplasty 18(7 Suppl 1):22–26

    Article  PubMed  Google Scholar 

  9. Fehring TK, Odum SM, Berend KR, Jiranek WA, Parvizi J, Bozic KJ et al (2013) Failure of irrigation and debridement for early postoperative periprosthetic infection. Clin Orthop Relat Res 471(1):250–257

    Article  PubMed  PubMed Central  Google Scholar 

  10. Gardner J, Gioe TJ, Tatman P (2011) Can this prosthesis be saved?: implant salvage attempts in infected primary TKA. Clin Orthop Relat Res 469(4):970–976

    Article  PubMed  PubMed Central  Google Scholar 

  11. Hossain F, Patel S, Haddad FS (2010) Midterm assessment of causes and results of revision total knee arthroplasty. Clin Orthop Relat Res 468(5):1221–1228

    Article  PubMed  PubMed Central  Google Scholar 

  12. Hsieh PH, Lee MS, Hsu KY, Chang YH, Shih HN, Ueng SW (2009) Gram-negative prosthetic joint infections: risk factors and outcome of treatment. Clin Infect Dis 49(7):1036–1043

    Article  PubMed  Google Scholar 

  13. Koh IJ, Cho WS, Choi NY, Kim TK, Kleos Korea Research G (2014) Causes, risk factors, and trends in failures after TKA in Korea over the past 5 years: a multicenter study. Clin Orthop Relat Res 472(1):316–326

    Article  PubMed  PubMed Central  Google Scholar 

  14. Konig DP, Schierholz JM, Munnich U, Rutt J (2001) Treatment of staphylococcal implant infection with rifampicin-ciprofloxacin in stable implants. Arch Orthop Trauma Surg 121(5):297–299

    Article  CAS  PubMed  Google Scholar 

  15. Koyonos L, Zmistowski B, Della Valle CJ, Parvizi J (2011) Infection control rate of irrigation and debridement for periprosthetic joint infection. Clin Orthop Relat Res 469(11):3043–3048

    Article  PubMed  PubMed Central  Google Scholar 

  16. Kurtz S, Ong K, Lau E, Mowat F, Halpern M (2007) Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 89(4):780–785

    Article  PubMed  Google Scholar 

  17. Kurtz SM, Lau E, Schmier J, Ong KL, Zhao K, Parvizi J (2008) Infection burden for hip and knee arthroplasty in the United States. J Arthroplasty 23(7):984–991

    Article  PubMed  Google Scholar 

  18. Kurtz SM, Lau E, Watson H, Schmier JK, Parvizi J (2012) Economic burden of periprosthetic joint infection in the United States. J Arthroplasty 27(8 Suppl):61–65

    Article  PubMed  Google Scholar 

  19. Kurtz SM, Ong KL, Schmier J, Mowat F, Saleh K, Dybvik E et al (2007) Future clinical and economic impact of revision total hip and knee arthroplasty. J Bone Joint Surg Am 89(Suppl 3):144–151

    Article  PubMed  Google Scholar 

  20. Laffer RR, Graber P, Ochsner PE, Zimmerli W (2006) Outcome of prosthetic knee-associated infection: evaluation of 40 consecutive episodes at a single centre. Clin Microbiol Infect 12(5):433–439

    Article  CAS  PubMed  Google Scholar 

  21. Marculescu CE, Berbari EF, Hanssen AD, Steckelberg JM, Harmsen SW, Mandrekar JN et al (2006) Outcome of prosthetic joint infections treated with debridement and retention of components. Clin Infect Dis 42(4):471–478

    Article  CAS  PubMed  Google Scholar 

  22. Meehan AM, Osmon DR, Duffy MC, Hanssen AD, Keating MR (2003) Outcome of penicillin-susceptible streptococcal prosthetic joint infection treated with debridement and retention of the prosthesis. Clin Infect Dis 36(7):845–849

    Article  CAS  PubMed  Google Scholar 

  23. Mont MA, Waldman B, Banerjee C, Pacheco IH, Hungerford DS (1997) Multiple irrigation, debridement, and retention of components in infected total knee arthroplasty. J Arthroplasty 12(4):426–433

    Article  CAS  PubMed  Google Scholar 

  24. Odum SM, Fehring TK, Lombardi AV, Zmistowski BM, Brown NM, Luna JT et al (2011) Irrigation and debridement for periprosthetic infections: does the organism matter? J Arthroplasty 26(6 Suppl):114–118

    Article  PubMed  Google Scholar 

  25. Osmon DR, Berbari EF, Berendt AR, Lew D, Zimmerli W, Steckelberg JM et al (2013) Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 56(1):e1–e25

    Article  PubMed  Google Scholar 

  26. Parvizi J, Gehrke T, International Consensus Group on Periprosthetic Joint Infection (2014) Definition of periprosthetic joint infection. J Arthroplasty 29(7):1331

    Article  PubMed  Google Scholar 

  27. Peel TN, Buising KL, Dowsey MM, Aboltins CA, Daffy JR, Stanley PA et al (2013) Outcome of debridement and retention in prosthetic joint infections by methicillin-resistant staphylococci, with special reference to rifampin and fusidic acid combination therapy. Antimicrob Agents Chemother 57(1):350–355

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Segawa H, Tsukayama DT, Kyle RF, Becker DA, Gustilo RB (1999) Infection after total knee arthroplasty. A retrospective study of the treatment of eighty-one infections. J Bone Joint Surg Am 81(10):1434–1445

    CAS  PubMed  Google Scholar 

  29. Sherrell JC, Fehring TK, Odum S, Hansen E, Zmistowski B, Dennos A et al (2011) The Chitranjan Ranawat Award: fate of two-stage reimplantation after failed irrigation and debridement for periprosthetic knee infection. Clin Orthop Relat Res 469(1):18–25

    Article  PubMed  PubMed Central  Google Scholar 

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

    Article  PubMed  Google Scholar 

  31. Tsukayama DT, Estrada R, Gustilo RB (1996) Infection after total hip arthroplasty. A study of the treatment of one hundred and six infections. J Bone Joint Surg Am 78(4):512–523

    CAS  PubMed  Google Scholar 

  32. Tsukayama DT, Goldberg VM, Kyle R (2003) Diagnosis and management of infection after total knee arthroplasty. J Bone Joint Surg Am 85-A(Suppl 1):S75–S80

    PubMed  Google Scholar 

  33. Van Kleunen JP, Knox D, Garino JP, Lee GC (2010) Irrigation and debridement and prosthesis retention for treating acute periprosthetic infections. Clin Orthop Relat Res 468(8):2024–2028

    Article  PubMed  PubMed Central  Google Scholar 

  34. Vilchez F, Martinez-Pastor JC, Garcia-Ramiro S, Bori G, Tornero E, Garcia E et al (2011) Efficacy of debridement in hematogenous and early post-surgical prosthetic joint infections. Int J Artif Organs 34(9):863–869

    Article  CAS  PubMed  Google Scholar 

  35. Wasielewski RC, Barden RM, Rosenberg AG (1996) Results of different surgical procedures on total knee arthroplasty infections. J Arthroplasty 11(8):931–938

    Article  CAS  PubMed  Google Scholar 

  36. Widmer AF, Gaechter A, Ochsner PE, Zimmerli W (1992) Antimicrobial treatment of orthopedic implant-related infections with rifampin combinations. Clin Infect Dis 14(6):1251–1253

    Article  CAS  PubMed  Google Scholar 

  37. Zimmerli W (2014) Clinical presentation and treatment of orthopaedic implant-associated infection. J Intern Med 276(2):111–119

    Article  CAS  PubMed  Google Scholar 

  38. Zimmerli W, Trampuz A, Ochsner PE (2004) Prosthetic-joint infections. N Engl J Med 351(16):1645–1654

    Article  CAS  PubMed  Google Scholar 

  39. Zimmerli W, Widmer AF, Blatter M, Frei R, Ochsner PE (1998) Role of rifampin for treatment of orthopedic implant-related staphylococcal infections: a randomized controlled trial. Foreign-Body Infection (FBI) Study Group. JAMA 279(19):1537–1541

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The Knee Multicenter Collaboration Team follows: Nam Yong Choi MD (Department of Orthopaedic Surgery, St. Paul’s Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea); Beom Koo Lee MD (Department of Orthopaedic Surgery, Gil Medical Center, Gachon University, Incheon, Korea); Churl Hong Chun MD (Department of Orthopaedic Surgery, Wonkwang University School of Medicine, Iksan, Korea); Seung-Baik Kang MD (Department of Orthopaedic Surgery, Seoul National University Boramae Hospital, Seoul, Korea); Jung-Ro Yoon MD (Department of Orthopaedic Surgery, VHS Medical center, Seoul, Korea) Jae Ang Sim MD (Department of Orthopaedic Surgery, Gil Medical Center, Gachon University, Incheon, Korea); Kwang-Am Jung MD (Department of Orthopaedic Surgery, Himchan Hospital, Seoul, Korea); Sae Kwang Kwon MD (Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Bucheon, Korea); Tae Kyun Kim MD (Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea); Seung-Bum Han MD (Department of Orthopaedic Surgery, Korea University Medical Center, Korea University College of Medicine, Seoul, Korea); Yong In MD (Department of Orthopaedic Surgery, Seoul St. Mary’s Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea); Kwang-Jun Oh MD (Department of Orthopaedic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea); Dae-Hee Lee MD (Department of Orthopaedic Surgery, Korea University Medical Center, Korea University College of Medicine, Seoul, Korea); In Jun Koh MD (Department of Orthopaedic Surgery, Seoul St. Mary’s Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea). We thank Chong Bum Chang MD (Seoul National University Bundang Hospital, Seongnam, Korea) for assistance in furnishing data and thank Jung-Hoon Do MD (St. Paul’s Hospital, Seoul, Korea); Young Gon Na MD, Sang Hwa Eom MD, Yeon Gwi Kang MS (Seoul National University Bundang Hospital, Seongnam, Korea); Se-Wook Park MD (Seoul St. Mary’s Hospital, Seoul, Korea); Ho Hyun Won MD (Himchan Hospital, Seoul, Korea); and Seon Hwa Lee BS (Yonsei Sarang Hospital, Bucheon, Korea) for their assistance in data collection.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Orthopaedics, Seoul St. Mary’s Hospital, Seoul, 137-701, Korea

    In Jun Koh & Yong In

  2. Department of Orthopaedics, The Catholic University of Korea College of Medicine, Seoul, 137-701, Korea

    In Jun Koh & Yong In

  3. Department of Orthopaedic Surgery, Korea University Medical Center, Korea University College of Medicine, Seoul, 136-705, Korea

    Seung-Bum Han & Dae-Hee Lee

  4. Department of Orthopaedic Surgery,Konkuk University Hospital, Konkuk University School of Medicine, Seoul, 143-729, Korea

    Kwang-Jun Oh

  5. Joint Reconstruction Center, Seoul National University Bundang Hospital, Seongnam, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Korea

    Tae Kyun Kim

  6. Department of Orthopaedics, Seoul National University College of Medicine, Seoul, 110-799, Korea

    Tae Kyun Kim

Authors
  1. In Jun Koh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Seung-Bum Han
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yong In
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kwang-Jun Oh
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Dae-Hee Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tae Kyun Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

on behalf of the Knee Multicenter Collaboration Team

Corresponding author

Correspondence to Tae Kyun Kim.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Koh, I.J., Han, SB., In, Y. et al. Open debridement and prosthesis retention is a viable treatment option for acute periprosthetic joint infection after total knee arthroplasty. Arch Orthop Trauma Surg 135, 847–855 (2015). https://doi.org/10.1007/s00402-015-2237-3

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-015-2237-3

Keywords

Search

Navigation