Open debridement and prosthesis retention is a viable treatment option for acute periprosthetic joint infection after total knee arthroplasty

Koh, In Jun; Han, Seung-Bum; In, Yong; Oh, Kwang-Jun; Lee, Dae-Hee; Kim, Tae Kyun

doi:10.1007/s00402-015-2237-3

Cited by 38 publications

(35 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…All patients with early superficial postoperative infection, 94% of patients with early deep postoperative infection, 96% of patients with late chronic infection, and 86% of patients with acute hematogenous infection maintained functioning knee prosthesis at the final follow-up (95% on average). In a recent study, Koh et al [13] found that the overall success rate of ODPLE was 71 %, and early postoperative infection and acute hematogenous infection had a success rate of 82 and 55 %, respectively. Success rate was associated with a shorter symptom duration in patients with acute hematogenous infections.…”

Section: Resultsmentioning

confidence: 99%

“…It seems ODPLE is not effective in most cases of acute infection after TKA. Therefore, in these cases, a two-stage revision arthroplasty must be indicated [1][2][3][4][5][6][7][8][9][10][11][12][13] .…”

Section: Resultsmentioning

confidence: 99%

“…ESR: Erythrocyte sedimentation rate. [5] Chin and Chen [6] Kim et al [8] Gardner et al [10] Koh et al [13] Mean Success Rate 35% 70% 95% 40% 82%…”

Section: Clinical Efficacymentioning

confidence: 99%

“…NA: Not available. Author Chin and Chen [6] Kim et al [8] Konigsberg et al [9] Koh et al [13] Mean Success Rate 50% 85% 75% 55%…”

Section: Clinical Efficacymentioning

confidence: 99%

“…The treatment for acute prosthetic knee infection is currently under debate [1][2][3][4] . Early open débridement with polyethylene liner exchange (ODPLE) is an attractive, but often ineffective strategy for the treatment of a TKA with acute infection [1][2][3][4][5][6][7][8][9][10][11][12][13] . The purpose of this article is to review the literature on acute infection after TKA with the aim of answering the following four questions: (1) Is ODPLE really effective?…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Acute Infection in Total Knee Arthroplasty (TKA): Is Early Open D閎ridement with Polyethylene Liner Exchange (ODPLE) Really Effective?Tendon Healing: Biological Principles And Augmentation with Autogenous Mesenchymal Stem Cells, Current Concepts

Rodríguez-Merchán¹

2015

International Journal of Orthopaedics

View full text Add to dashboard Cite

viable treatment option for acute prosthetic joint infection following TKA. The promptness of ODPLE is of paramount importance for success of the procedure. In Staphylococcus aureus infections the mean success rate is 7%, while in Streptococcal or Staphylococcus epidermidis species the mean success rate is 47%. The success rate of two-stage revision for infection is diminished after a failed ODPLE (66% mean success rate). It seems that acute infections after TKA in the presence of Staphylococcus aureus must be treated by a two-stage revision arthroplasty. Key words: INTRODUCTIONWhile infection in total knee arthroplasty (TKA) is a relatively infrequent complication, it can be devastating in terms of morbidity and cost. The risk of infection ranges from 0.5% to 2% for primary TKAs. The treatment for acute prosthetic knee infection is currently under debate [1][2][3][4] . Early open débridement with polyethylene liner exchange (ODPLE) is an attractive, but often ineffective strategy for the treatment of a TKA with acute infection [1][2][3][4][5][6][7][8][9][10][11][12][13] . The purpose of this article is to review the literature on acute infection after TKA with the aim of answering the following four questions: (1) Is ODPLE really effective? (2) What is the success rate of early ODPLE? (3) Which factors can predict control of infection after early ODPLE; (4) Is the success rate of two-stage revision for infection diminished after a failed early ODPLE? ABSTRACTBackground: Open débridement with polyethylene liner exchange (ODPLE) is an attractive strategy for the treatment of a total knee arthroplasty (TKA) with acute infection. Purpose: The purpose of this article is to review the literature on acute infection after TKA with the aim of answering the following four questions: (1) Is ODPLE really effective? (2) What is the success rate of ODPLE? (3) Which factors can predict control of TKA acute infection after early ODPLE? (4) Is the success rate of two-stage revision for infection diminished after a failed early ODPLE? Methods: The search engines were MedLine, EMBASE and the Cochrane Library. The keywords used were: acute TKA infection. Fifty-three articles were found until 20 October 2015. Of those, only thirteen were selected and reviewed because they were strictly focused on the topic and the questions of this article. Results: Although the level of evidence of published papers is low, the mean success rate in postoperative acute infections ranged between 35% and 95%, and between 50% and 85% 70% in acute hematogenous infections. The only factor that can predict control of infection after ODPLE is the type of infected organism (Staphylococcus aureus 7% success rate, Staphylococcus epidermidis and Streptococcus species 47% success rate). The success rate of two-stage revision is diminished after a failed ODPLE (66% success rate). Conclusions: ODPLE should be considered as a REVIEW

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…ESR: Erythrocyte sedimentation rate. [5] Chin and Chen [6] Kim et al [8] Gardner et al [10] Koh et al [13] Mean Success Rate 35% 70% 95% 40% 82%…”

Section: Clinical Efficacymentioning

confidence: 99%

“…NA: Not available. Author Chin and Chen [6] Kim et al [8] Konigsberg et al [9] Koh et al [13] Mean Success Rate 50% 85% 75% 55%…”

Section: Clinical Efficacymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Acute Infection in Total Knee Arthroplasty (TKA): Is Early Open D閎ridement with Polyethylene Liner Exchange (ODPLE) Really Effective?Tendon Healing: Biological Principles And Augmentation with Autogenous Mesenchymal Stem Cells, Current Concepts

Rodríguez-Merchán¹

2015

International Journal of Orthopaedics

View full text Add to dashboard Cite

show abstract

Gelenkinfektionen der Hand

Unglaub

Langer

Unglaub³

et al. 2016

Unfallchirurg

View full text Add to dashboard Cite

Joint infections of the hand may lead to irreversible lesions and impairment of hand function due to early cartilage damage. Furthermore, persistent infections which are not treated immediately can cause osteitis and/or spread systemically. Finger joints are prone to infection due to bite wounds or crush and sharp injuries. Whereas the wrist is often affected in patients with immunosuppression or chronic diseases, such as diabetes mellitus. If diagnosis and therapy are delayed, joint damage may be inevitable. Therefore, urgent treatment of the infected joint is imperative to preserve the function of the hand. This article reviews the current diagnostics and treatment of joint infections of the hand.

show abstract

Negative impact of prior debridement on functional outcome of subsequent two-stage revision for early knee periprosthetic infection

Lizaur-Utrilla

Asensio-Pascual

González-Parreño

et al. 2019

Knee Surg Sports Traumatol Arthrosc

View full text Add to dashboard Cite

Purpose To compare the functional outcome of two‐stage revision (2SR) in patients without a prior debridement, antibiotics and implant retention with those patients who underwent 2SR after a failed debridement, antibiotics and implant retention for early periprosthetic joint infection following total knee arthroplasty (TKA). Negative impact of prior failed debridement, antibiotics and implant retention on the functional outcome of subsequent 2SR was hypothesized. Methods Case–control study of 49 patients initially treated with 2SR (group A) and 43 treated with 2SR after a prior failed debridement, antibiotics and implant retention (group B). Functional outcome was assessed by the Knee Society Scores (KSS) and Western Ontario and McMaster Universities (WOMAC) questionnaire. Range of motion (ROM) of the knee was also measured. Results The median follow‐up was 4.1 (range 3–7) years. At final follow‐up, KSS‐knee (p = 0.001), KSS‐function (p = 0.002), WOMAC‐function (p = 0.022) and ROM (p = 0.002) were significantly better in the group A as compared to the group B. There was no significant difference between groups in the WOMAC‐pain score (p = 0.597). In multivariate analysis, BMI < 30 (OR 3.1, 95% CI 1.7–4.9, p = 0.026), non‐ Staphylococcus causative microorganism (OR 2.7, 95% CI 1.6–5.9, p = 0.037), and 2SR procedure (OR 2.4, 95% CI 1.7–5.2, p = 0.018) were significant predictors of successful functional outcome. Conclusions A prior debridement, antibiotics and implant retention has been shown to have a negative impact on the functional outcome of a subsequent 2SR. These findings suggest that treatment with debridement, antibiotics and implant retention for early periprosthetic infection should only be used in selected patients, and the first option in those patients with Staphylococcus organisms should be 2SR. Level of evidence IV.

show abstract

Open debridement and prosthesis retention is a viable treatment option for acute periprosthetic joint infection after total knee arthroplasty

Abstract: ODPR should be considered as a viable treatment option for acute PJI following TKA. The promptness of ODPR is of paramount importance for success of ODPR, rather than the causative organism type or virulence.

Cited by 38 publications

References 42 publications

Acute Infection in Total Knee Arthroplasty (TKA): Is Early Open D閎ridement with Polyethylene Liner Exchange (ODPLE) Really Effective?Tendon Healing: Biological Principles And Augmentation with Autogenous Mesenchymal Stem Cells, Current Concepts

Acute Infection in Total Knee Arthroplasty (TKA): Is Early Open D閎ridement with Polyethylene Liner Exchange (ODPLE) Really Effective?Tendon Healing: Biological Principles And Augmentation with Autogenous Mesenchymal Stem Cells, Current Concepts

Gelenkinfektionen der Hand

Negative impact of prior debridement on functional outcome of subsequent two-stage revision for early knee periprosthetic infection

Contact Info

Product

Resources

About