Is There Still a Role for Irrigation and Debridement with Liner Exchange in Acute Periprosthetic Total Knee Infection?

• Published in: The Journal of arthroplasty Vol. 32; no. 4; pp. 1280 - 1284
• Main Authors: Duque, Andrés, MD MSc, Post, Zachary, MD, Lutz, Rex, BS, Orozco, Fabio, MD, Pulido, Sergio H., DO, Ong, Alvin, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2017
• Subjects: acute periprosthetic joint infection; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents - administration & dosage; Arthritis, Infectious - etiology; Arthritis, Infectious - surgery; Arthroplasty, Replacement, Knee - adverse effects; debridement; Debridement - methods; Debridement - statistics & numerical data; Female; Humans; infection; irrigation; Knee Joint - surgery; Male; Methicillin-Resistant Staphylococcus aureus - isolation & purification; Middle Aged; Orthopedics; Polyethylene; Postoperative Period; Prosthesis-Related Infections - microbiology; Prosthesis-Related Infections - surgery; Retrospective Studies; Synovectomy; Therapeutic Irrigation - methods; Therapeutic Irrigation - statistics & numerical data; total knee arthroplasty; Treatment Outcome; Erytrocyte Sedimentation Rate; CRP; infection; C-Reactive Protein; ESR; Periprosthetic Joint Infection; debridement; acute periprosthetic joint infection; TKA; Methicillin Resistant Staphylococcus Aureus; PJI; total knee arthroplasty; I&D/L; irrigation; Irrigation and Debridement with Liner Exchange; MRSA
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/j.arth.2016.10.029

Abstract Background Periprosthetic joint infection (PJI) is an important cause of failure in total knee arthroplasty (TKA). Irrigation and debridement with liner exchange (I&D/L) success rates have varied for acute PJI. The purpose of this study is to present results of a specific protocol for I&D/L with retention of TKA components. Methods Sixty-seven consecutive I&D/L patients were retrospectively evaluated. Inclusion criteria for I&D/L were: fewer than 3 weeks of symptoms, no immunologic compromise, intact soft tissue sleeve, and well-fixed components. I&D/L consisted of extensive synovectomy, irrigation with 3 liters each of Betadine, Dakin’s, bacitracin, and normal saline solutions, and exchange of the polyethylene component. Postoperatively, all patients were treated with intravenous antibiotics. Infection was considered eradicated if the wound healed without persistent drainage, there was no residual pain or evidence of infection. Results Forty-six patients (68.66%) had successful infection eradication regardless of bacterial strain. Those with MRSA had an 80% failure rate and those with Pseudomonas aeruginosa had a 66.67% failure rate. The success rate for bacteria other than MRSA and Pseudomonas was 85.25%1. Conclusion Our protocol for I&D/L was successful in the majority of patients who met strict criteria. We recommend that PJI patients with MRSA or Pseudomonas aeruginosa not undergo I&D/L and be treated with two-stage revision. For nearly all other patients our protocol avoids the cost and patient morbidity of a two-stage revision.