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Failure of Irrigation and Débridement for Early Postoperative Periprosthetic Infection

  • Symposium: Papers Presented at the Annual Meetings of the Knee Society
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Irrigation and débridement (I&D) of periprosthetic infection (PPI) is associated with infection control ranging from 16% to 47%. Mitigating factors include organism type, host factors, and timing of intervention. While the influence of organism type and host factors has been clarified, the timing of intervention remains unclear.

Questions/Purposes

We addressed the following questions: What is the failure rate of I&Ds performed within 90 days of primary surgery? And what factors are associated with failure?

Methods

We performed a multicenter retrospective analysis of I&D for PPI within 90 days of primary surgery. We included 86 patients (44 males, 42 females) with an average age of 61 years. Failure was defined as return to the operating room for an infection-related problem. We determined the failure rate of I&D within 90 days of primary surgery and whether the odds of rerevision for infection were associated with Charlson Comorbidity Index, age, sex, joint, organism type, and timing. The minimum followup was 24 months (average, 46 months; range, 24–106 months).

Results

54 of 86 patients (63%) failed. Eight of 10 (80%) failed within the first 10 days, 32 of 57 (56%) within 4 weeks, and 22 of 29 (76%) within 31 to 90 days postoperatively. No covariates were associated with subsequent revision surgery for infection.

Conclusions

I&D for PPI is frequently used in the early postoperative period to control infection. While it is assumed early intervention will lead to control of infection in most cases, our data contradict this assumption.

Level of Evidence

Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

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Acknowledgments

The authors thank the following individuals for their help with this project: Bahar Adeli (Rothman Institute), Vanessa Chiu (University of California, San Francisco), Robert Cope (OrthoCarolina), Keith Fehring, MD (Virginia Commonwealth University), Pat Knickerbocker (Minneapolis Veterans Affairs Medical Center), Michal Sneller (Joint Implant Surgeons), and Matthew Tetreault (Rush University Medical Center).

Author information

Authors and Affiliations

  1. OrthoCarolina, PA, Hip and Knee Center, 2001 Vail Avenue, Suite 200-A, Charlotte, NC, 28207, USA

    Thomas K. Fehring MD

  2. OrthoCarolina Research Institute, Inc, Charlotte, NC, USA

    Susan M. Odum MEd

  3. Joint Implant Surgeons, Inc, New Albany, OH, USA

    Keith R. Berend MD

  4. Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA, USA

    William A. Jiranek MD

  5. Rothman Institute, Philadelphia, PA, USA

    Javad Parvizi MD

  6. Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA

    Kevin J. Bozic MD

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

    Craig J. Della Valle MD

  8. Department of Orthopaedic Surgery, Minneapolis Veterans Affairs Medical Center, Minneapolis, MN, USA

    Terence J. Gioe MD

Authors
  1. Thomas K. Fehring MD
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  3. Keith R. Berend MD
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  4. William A. Jiranek MD
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  7. Craig J. Della Valle MD
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  8. Terence J. Gioe MD
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Corresponding author

Correspondence to Thomas K. Fehring MD.

Additional information

Each author certifies that he or she, or a member of his or her immediate family, 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.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

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.

Data were collected at each institution. Data analysis was conducted at OrthoCarolina Research Institute, Charlotte, NC, USA.

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Fehring, T.K., Odum, S.M., Berend, K.R. et al. Failure of Irrigation and Débridement for Early Postoperative Periprosthetic Infection. Clin Orthop Relat Res 471, 250–257 (2013). https://doi.org/10.1007/s11999-012-2373-9

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  • DOI: https://doi.org/10.1007/s11999-012-2373-9

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