Infection Control Rate of Irrigation and Débridement for Periprosthetic Joint Infection

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%

Swab Cultures Are Not As Effective As Tissue Cultures for Diagnosis of Periprosthetic Joint Infection

“…Acute postoperative PJI was diagnosed if infection occurred within 6 weeks of index primary joint arthroplasty [3]. Acute delayed PJI was diagnosed if onset of symptoms occurred abruptly in a previously well-functioning joint [9]. Chronic PJI was suspected when infection was diagnosed after 6 weeks from index primary joint arthroplasty with symptoms of persistent joint pain or discomfort since surgery.…”

Outcome of One-stage Cementless Exchange for Acute Postoperative Periprosthetic Hip Infection

“…Other authors have indicated that regardless of the treatment modality, whether I&D [3,7] or one-stage [16] or two-stage exchange [17,19,21,36], infections caused by the more virulent organisms have a higher failure rate. Although our study was underpowered to draw definitive conclusions regarding implant retention based on organism, we are also concerned whether cementless single-stage exchange arthroplasty can control MRSA infection supporting prior authors' results [3,7,14,18] that these patients may best be treated with a two-stage exchange arthroplasty.…”

“…Although a number of publications have been described the outcomes of irrigation and débridement (I&D) with modular component exchange for periprosthetic joint infection (PJI) [1,3,7,8,13,15,18,20], the majority of published research on the topic has combined cohorts of patients (eg, hip versus knee and timing of infection) [3,18,22,31], thus making it difficult to tease out the differential success rates of the procedure for periprosthetic hip versus knee infection or type of infection (acute hematogenous versus chronic versus acute postoperative) ( Table 3). As well, it is likely that variations of defining treatment success, in this case component retention, contribute to the variation in reported outcomes.…”

“…The dismal ability of I&D to control acute postoperative infections has been reported in larger, mixed cohorts of acute postoperative infections of the hip and knee. Koyonos et al [18] reported a rate of infection control of 31% (16 of 52) as defined by the absence of further surgery related to infection or need for suppressive antibiotics, whereas Azzam et al [3] reported a 48% (20 of 58) rate of controlling infection as defined by the absence of signs and symptoms of infection in their cohort with acute postoperative infections. Furthermore, concern has been expressed that an initial I&D may compromise the ultimate ability of a subsequent two-stage exchange arthroplasty to control infection.…”

“…By decreasing the intraarticular bacterial load and exchanging the modular parts, one could potentially control the infection, retain the prior implants, and minimize morbidity to the patient. However, several publications have demonstrated a failure rate, as defined as recurrent infection, component removal, or need for additional surgery resulting from infection, of 12% to 86% in series ranging from 20 to 138 patients [1,8,13,18,20,29]. In response to the unpredictability of this approach to control the infection, some have suggested a one-stage exchange arthroplasty as an alternative because it allows more thorough surgical débridement and removal of biofilm-colonized implants [2,4,16,34].…”