Irrigation and Debridement Before a 2-Stage Revision Total Knee Arthroplasty Does Not Increase Risk of Failure

Abstract

Background Studies have suggested that the success of two-stage revision total knee arthroplasty (rTKA) may be compromised by a prior failed irrigation and debridement (I&D). The purpose of this study was to use two large state inpatient databases to compare the two-stage rTKA failure rates for those patients with and without a prior I&D. Methods This retrospective, longitudinal study used inpatient discharge data from the State Inpatient Database (SID) of two states (California and New York) from 2005 to 2011. A combination of ICD-9 diagnosis and procedure codes were used to identify rTKA patients, and compare failure rates for rTKA patients with and without prior I&D. The primary outcome was failure of the staged revision, which was defined as subsequent surgery due to infection within four years of the two-stage rTKA. Results Of the 750 patients who underwent two-stage rTKA, fifty-seven had undergone a prior I&D. In all, 126 patients failed rTKA. After four years, the estimated failure rate was 8.7% (95% CI 1.9% – 16.9%) in the group with prior I&D and 17.5% (95% CI 14.7% – 20.4%) in the group without prior I&D. After adjusting for gender, race, insurance, median household income, and comorbidities, the hazard ratio for the group with a failed I&D was 0.49 (p=0.122; 95% CI 0.20 – 1.20) which indicated a lower risk of failure compared to the group without prior I&D. Conclusions These findings indicate that the failure rate of two-stage rTKA is not increased by prior failed I&D.

Nano-carrier based drug delivery systems for sustained antimicrobial agent release from orthopaedic cementous material

“…Management of prosthetic infections should be customised for each patient and usually includes one of 3 main types of surgical interventions [29,84]. First, prosthetic retention with debridement of all infected tissue and irrigation, which is a choice for early postoperative or late haematogenous infections with retention of the prosthesis and long term antibiotic treatment [85,86]. Second, prosthetic exchange, the most frequently used, by one stage or two stage revision.…”

Risk of Reinfection after Irrigation and Debridement of Acute Periprosthetic Joint Infection following TKA

“…11 It has been demonstrated that treatment of an acute PJI with I&D as the initial treatment does not compromise the subsequent two-stage procedure if this initial treatment modality fails. 12 The surgical decision process can be complex and surgeons take multiple factors into consideration such as the acuity of the infection, virulence of the organism, and variety of patient-related factors when formulating a treatment plan.…”

Treatment of Prosthetic Joint Infection with Debridement, Antibiotics and Irrigation with Implant Retention - a Narrative Review

“…Another treatment alternative is to proceed to implant removal. Although the real impact of previous failed DAIR on the likelihood of success after exchange surgery is not yet fully understood, most surgeons would agree that exchange surgery is the natural choice when facing a late infection relapse 3 , 4 , 91 . The same might be true in some cases of early failure, especially if significant risk factors for DAIR failure are present (e.g.…”