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Can This Prosthesis Be Saved?: Implant Salvage Attempts in Infected Primary TKA

  • Symposium: Periprosthetic Joint Infection
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Open débridement with polyethylene liner exchange (ODPE) remains a relatively low morbidity option in acute infection of total knee arthroplasty (TKA), but concerns regarding control of infection exist. We sought to identify factors that would predict control of infection after ODPE.

Methods

We identified 44 patients (44 knees) with culture-positive periprosthetic infection who underwent ODPE. Failure was defined as any reoperation performed for control of infection or the need for lifetime antibiotic suppression. Patients had been followed prospectively for a minimum of 1 year (mean, 5 years; range, 1–9 years).

Results

Twenty-five of the 44 patients (57%) failed ODPE. Of these 25 patients, two had one additional procedure, 21 had more than one additional procedure, and two required lifetime antibiotic suppression. Failure rates tended to differ based on primary organism: 71% of Staphylococcus aureus periprosthetic infection failed versus 29% of Staphylococcus epidermidis, although with the limited numbers theses differences were not significant. Age, gender, or measures of comorbidity did not influence the risk of failure. There was no difference in failure rate (58% versus 50%) when the ODPE was performed greater than 4 weeks after index TKA. After a failed ODPE, 19 of the 25 failures went on to an attempted two-stage revision procedure. In only 11 of these 19 cases was the two-stage revision ultimately successful.

Conclusions

Eradication of infection with ODPE in acute TKA infections is unpredictable; certain factors trend toward increased success but no firm algorithm can be offered. The success of two-stage revision for infection may be diminished after a failed ODPE.

Level of Evidence

Level III, retrospective comparative study. See Guidelines for Authors for a complete description of levels of evidence.

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Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Minnesota Medical School, Minneapolis, MN, USA

    Jeremy Gardner MD & Terence J. Gioe MD

  2. Department of Orthopaedic Surgery, Minneapolis VAMC, Section 112E, 1 Veterans Drive, Minneapolis, MN, 55417, USA

    Terence J. Gioe MD

  3. HealthEast Research and Education, St Paul, MN, USA

    Penny Tatman MPH

Authors
  1. Jeremy Gardner MD
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  2. Terence J. Gioe MD
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  3. Penny Tatman MPH
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Corresponding author

Correspondence to Terence J. Gioe 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, and that informed consent for participation in the study was obtained.

This work was performed at the Minneapolis Veterans Administration Medical Center and the HealthEast Hospitals, St Paul, MN, USA.

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Gardner, J., Gioe, T.J. & Tatman, P. Can This Prosthesis Be Saved?: Implant Salvage Attempts in Infected Primary TKA. Clin Orthop Relat Res 469, 970–976 (2011). https://doi.org/10.1007/s11999-010-1417-2

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  • DOI: https://doi.org/10.1007/s11999-010-1417-2

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