Aggressive Early Débridement for Treatment of Acutely Infected Cemented Total Hip Arthroplasty

Aggressive Early Debridement in Treatment of Acute Periprosthetic Joint Infections After Hip and Knee Replacements

“…Meehan et al [28] reported worse infection control rates when the treatment was started after 4 days. Sukeik et al [11] reported good infection eradication after total hip replacement (THR) when the intervention was commenced within 5 days (90% infection control vs . 77% for treatment within 6 weeks) and another case series by Peel et al [29] showed better outcomes when treatment was instigated within 24h of symptoms onset.…”

“…Several authors [6, 11, 26, 31-33] suggested exchanging the polyethylene liner or modular parts of the prosthesis, especially for total knee replacements (TKRs) to access the posterior capsule and perform an extensive debridement. In particular, a recent multi-centered study including hip and knee arthroplasties found that exchanging the modular component of the prosthesis reduced the risk of failure by 33% [31].…”

“…Additionally, the early removal of all modular components may prevent formation of the resistant biofilm and reduce the overall bacterial burden. All retained components should be scrubbed with bacterocidial solutions such as sodium hypochlorite (Dakin’s solution) [2], or diluted betadine [11]. Copious irrigation with 6-9L using pulse lavage should be performed [2, 11, 32].…”

Increased risk of joint failure in hip prostheses infected with Staphylococcus aureus treated with debridement, antibiotics and implant retention compared to Streptococcus

“…Nevertheless, for patients with advanced age, severe co-morbidities [2] and anticipated anaesthesiological problems [3,4], or for acute infections occurring within less than three to four weeks, a debridement, prolonged antibiotics and implant retention (DAIR) approach [1,[4][5][6][7] may be attempted following experts' recommendations. Contraindications for DAIR are considered the presence of a sinus tract, implant loosening and maybe delay in debridement for more than one month [3]. Infection due to methicillin-resistant Staphylococcus aureus (MRSA) could also worsen the prognosis [5] because of the limited availability of bactericidal antibiotics and potential emergence of glycopeptide resistance in vancomycin-treated patients [8].…”

Pasteurella multocida infection in a primary shoulder arthroplasty after cat scratch: case report and review of literature

“…Prosthetic joint infection occurs in approximately 1% to 2% of joint arthroplasties, 16,21,24 which can be devastating to the patient functionally, emotionally, and financially. 9 Our patient reported sustaining 2 cat scratches on his hand that preceded the subsequent fevers and development of shoulder pain after a period of initial improvement postoperatively.…”