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Infection Control Rate of Irrigation and Débridement for Periprosthetic Joint Infection

  • Symposium: Papers Presented at the 2010 Meeting of the Musculoskeletal Infection Society
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Irrigation and débridement with retention of prosthesis is commonly performed for periprosthetic joint infection. Infection control is reportedly dependent on timing of irrigation and débridement relative to the index procedure.

Questions/purposes

We therefore (1) compared the ability of irrigation and débridement to control acute postoperative, acute delayed, and chronic infections and (2) determined whether any patient-related factors influenced infection control.

Patients and Methods

We retrospectively reviewed the records of 136 patients (138 joints) from two institutional databases treated with irrigation and débridement between 1996 and 2007. Mean age at time of treatment was 64 years (range, 18–89 years); 77 (56%) joints were in women. Three subgroups were extracted: acute postoperative infections, occurring within 4 weeks (52 joints), acute delayed infections occurring after 4 weeks with acute onset of symptoms (50 joints), and chronic infections (36 joints). Minimum followup was 12 months (average, 54 months; range, 12–115 months). Failure to control infection was reported as the need for any subsequent surgical intervention and/or use of long-term suppressive antibiotics.

Results

Infection control was not achieved in 90 joints (65%; 82 requiring return to surgery and eight remaining on long-term suppressive antibiotics). Failure rates were 69% (36 of 52), 56% (28 of 50), and 72% (26 of 36) for acute postoperative, acute delayed, and chronic infections, respectively. Of the 10 variables considered as potential risk factors, only Staphylococcal organisms predicted failure.

Conclusions

Irrigation and débridement is unlikely to control periprosthetic joint infection, including acute infections. Our data suggest surgeons should be cautious using this procedure as a routine means to address periprosthetic joint infection. For most patients, we recommend irrigation and débridement be reserved for an immunologically optimized host infected acutely with a non-Staphylococcal organism.

Level of Evidence

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

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Acknowledgments

We thank Catherine J. Fedorka, MD, and Nicholas Brown, BS, for assistance in collecting data.

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Authors and Affiliations

  1. The Rothman Institute of Orthopaedics, Thomas Jefferson University Hospital, 925 Chestnut Street, 5th Floor, Philadelphia, PA, 19107, USA

    Loukas Koyonos MD, Benjamin Zmistowski BS & Javad Parvizi MD, FRCS

  2. Rush University Medical Center, Chicago, IL, USA

    Craig J. Della Valle MD

Authors
  1. Loukas Koyonos MD
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  2. Benjamin Zmistowski BS
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  3. Craig J. Della Valle MD
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  4. Javad Parvizi MD, FRCS
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Corresponding author

Correspondence to Javad Parvizi MD, FRCS.

Additional information

Javad Parvizi is a consultant for Stryker Orthopaedics (Mahwah, NJ) and has intellectual properties on SmarTech (Philadelphia, PA); Craig J. Della Valle is a consultant to Smith and Nephew Inc (Memphis, TN), Biomet Inc (Warsaw, IN), and Kinamed Inc (Camarillo, CA). Loukas Koyonos and Benjamin Zmistowski certify that they have 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. The authors’ institution did not receive any funding in support of this research project.

Each author certifies that his/her institution has approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

This work was performed at The Rothman Institute of Orthopaedics and the Rush University Medical Center.

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Koyonos, L., Zmistowski, B., Della Valle, C.J. et al. Infection Control Rate of Irrigation and Débridement for Periprosthetic Joint Infection. Clin Orthop Relat Res 469, 3043–3048 (2011). https://doi.org/10.1007/s11999-011-1910-2

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  • DOI: https://doi.org/10.1007/s11999-011-1910-2

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