Outcome of Irrigation and Debridement after Failed Two-Stage Reimplantation for Periprosthetic Joint Infection

Abstract

Introduction Two-stage revision is the gold standard for the treatment of deep implant infection after knee or hip arthroplasty. Irrigation and debridement may be a treatment option for failed 2-stage revisions in cases where a reinfection occurs within 30 days or the symptoms exist not longer than 3 weeks and is appealing because of its low morbidity. We determined the incidence of recurrent infections following irrigation and debridement for failed two-stage revision hip and knee arthroplasty. Methods We performed a single center retrospective review of periprosthetic hip and knee infections treated with a two-stage procedure from 2002 to 2010. All patients that subsequently underwent irrigation and debridement for a subsequent infection were selected for the current study. Results 440 two-stage revisions were performed between 2002 and 2010. Fifty-one two-stage revisions failed (11.6%). Nineteen failed two-stage revisions were treated with irrigation and debridement; 12 (63.2%) patients remained free of infection at follow-up (mean follow-up: 39 months; range, 24-90 months), infection persisted in 6 patients (31.6%), and 1 patient died (5.3%). Conclusions Success rates of irrigation and debridement for failed two-stage procedures are similar to the success rates of irrigation and debridement in primary implant infections. According to the current paper, irrigation and debridement are an acceptable treatment for acute reinfections after failed two-stage revision if performed within the first 30 postoperative days after failed two-stage procedure or if symptoms are present for less than 3 weeks in the presence of a susceptible organism.

Debridement, Antibiotics and Implant Retention: A Systematic Review of Strategies for Treatment of Early Infections after Revision Total Knee Arthroplasty

“…Previously, guidelines for the treatment of PJIs as introduced by Osmon et al [28] recommend a DAIR for patients with an acute PJI, no implant loosening and without the presence of a sinus tract. However, only Faschingbauer et al [16] excluded patients with the presence of a sinus tract. This is in contrast with the articles of Veerman et al [14] and Bongers et al [20], who specifically mention a sinus tract as an indication for DAIR or its resection as part of the DAIR procedure.…”

“…An overview is shown in Table 1. The study of Faschingbauer et al [16] specifically describes cleaning of the surgical field, new instruments and new gloves for the surgeon following irrigation. If they were not able to close the wound properly, a vacuum-assisted closure system (VAC) was used.…”

“…From the patients with a type III infection (acute hematogenous) (n = 10), 50% were successful (n = 5) and the infection was eradicated after two-stage revision (n = 3) and after arthrodesis (n = 2). In the study of Faschingbauer et al [16], the incidence of re-infection after 440 two-stage septic revision total hip and knee arthroplasties was reported. The overall re-infection-rate was 11.6% (n = 51).…”

Vacuum-assisted healing of various-aetiology wounds: A systematic review

“…Также имеется множество упоминаний использования метода вакуумной терапии в лечении ран и инфекционных осложнений после ортопедо-травматологических операций [40,41]. В рандомизированном исследовании J. Вакуумная терапия создает оптимальные условия для приживления аутодермотрансплантатов, сокращает сроки подготовки раны к аутопластике и активно используется в комбустиологии [14].…”