The Preoperative Prediction of Success Following Irrigation and Debridement With Polyethylene Exchange for Hip and Knee Prosthetic Joint Infections

Buller, Leonard T.; Sabry, Fady Youssef; Easton, Robert W.; Klika, Alison K.; Barsoum, Wael K.

doi:10.1016/j.arth.2012.01.003

Cited by 146 publications

(130 citation statements)

References 33 publications

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“…Studies have shown that the patient's general health has a direct link with postoperative complications. An American Society of Anesthesiologists score of greater than 2, uncontrolled diabetes, and rheumatoid arthritis, for example, can significantly increase the risk of PJI (18,20,(23)(24)(25). Furthermore, any other comorbidity accompanied by diabetes is shown to place patients at a cumulatively higher risk for infection (21,26).…”

Section: Medical Optimization Of Hostmentioning

confidence: 99%

Prevention of Periprosthetic Joint Infection

Rezapoor

Parvızı

2015

The Journal of Arthroplasty

121

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Section: Medical Optimization Of Hostmentioning

confidence: 99%

Prevention of Periprosthetic Joint Infection

Rezapoor

Parvızı

2015

The Journal of Arthroplasty

121

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“…Infection is a leading cause for revision total knee arthroplasty (RTKA) [11,12]. Studies have shown that 6.6% to 38% of RTKAs are attributable to prosthetic knee infections [5,11,23,24,31,41,43,55,58,76,95,96].…”

Section: Introductionmentioning

confidence: 99%

Tibial Tubercle Osteotomy or Quadriceps Snip in Two-stage Revision for Prosthetic Knee Infection? A Randomized Prospective Study

Bruni

Iacono

Sharma

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Although 7% to 38% of revision total knee arthroplasties (RTKAs) are attributable to prosthetic knee infections, controversy exists regarding the best surgical approach while reducing the risk of extensor mechanism complications and the reinfection rate. Questions/purposes We compared The Knee Society Score Ó (KSS), incidences of complications, maximum knee flexion, residual extension lag, and reinfection rate in patients with prosthetic knee infections treated with two-stage RTKAs using either the tibial tubercle osteotomy (TTO) or the quadriceps snip (QS) for exposure at the time of reimplantation. Methods We prospectively followed 81 patients with chronic prosthetic knee infections treated between 1997 and 2004. Patients were randomized to receive a TTO or QS for exposure at the time of reimplantation. All patients had the same rehabilitation protocol. The minimum followup was 8 years (mean, 12 years; range, 8-15 years). Results Patients in the TTO group had a higher mean KSS than the QS group (88 versus 70, respectively). Mean maximum knee flexion was greater in the TTO group (113°v ersus 94°); with a lower incidence of extension lag (45% versus 13%). We observed no differences in reinfection rate between groups. Conclusions We found the TTO combined with an early rehabilitation protocol associated with superior KSS did not impair extensor mechanism function or increase the reinfection rate. We believe a two-stage RTKA with TTO is a reasonable approach for treating prosthetic knee infections.

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“…The duration of the presenting symptoms and the time after initial surgery are also important contributors to treatment success, or failure. Some studies state that treatment outcomes decline when the patients undergo a debridement a mere > 2 d after onset of symptoms [79] , whereas other studies claim the cutoff is at 7 d [53] , 21 d [47] or even 28 d [62,80] . The time after index surgery showed an even greater scope, ranging from 15 d [81] to two years [82] .…”

Section: Discussionmentioning

confidence: 99%

“…Vilchez, Choi and Deiermengian all specifically mention S. aureus as being much more virulent than other micro-organisms (possibly due to their biofilm production) and having a significant, negative influence on treat outcome [45,74,75] . Peel et al [76] specifically state MRSA infections as leading to a significant decrease in treatment success whereas Kuiper et al [53] report that coagulase negative Staphylococcus Azzam et al [6] Retrospective cohort -104 51 53 -46 44% 68 Odum et al [17] Retrospective cohort -150 53 97 -46 31% n.m. 1 Byren et al [43] Retrospective cohort -112 52 51 9 92 82% 27 Lora Tamayo et al [44] Retrospective cohort Staphylococcus aureus PJI 345 146 195 4 199 55% n.m. Cobo et al [46] Prospective cohort Early infections (< 30 d) 117 69 53 17 67 57% 24 Buller et al [47] Retrospective cohort -309 62 247 -160 52% 34 Koyonos et al [48] Retrospective cohort -138 60 78 -48 35% 54 El Helou et al [73] Prospective cohort compared to 2 retrospective cohorts Staphylococcal PJI 101 40 61 -69 68% 12 Tornero et al [81] Retrospective resulting from PJI. In the majority of the studies, after DAIR failure, most patients were treated with two-stage revision, but one-stage revision, resection arthroplasty without reimplantation and chronic suppression with antibiotics were described as well [15,16,52,62,[83][84][85] .…”

Section: Risk Factors For Dair Treatment Failurementioning

confidence: 99%

Treatment of acute periprosthetic infections with prosthesis retention: Review of current concepts

Kuiper

Willink

Moojen

et al. 2014

WJO

109

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Periprosthetic joint infection (PJI) is a devastating complication after total joint arthroplasty, occurring in approximately 1%-2% of all cases. With growing populations and increasing age, PJI will have a growing effect on health care costs. Many risk factors have been identified that increase the risk of developing PJI, including obesity, immune system deficiencies, malignancy, previous surgery of the same joint and longer operating time. Acute PJI occurs either postoperatively (4 wk to 3 mo after initial arthroplasty, depending on the classification system), or via hematogenous spreading after a period in which the prosthesis had functioned properly. Diagnosis and the choice of treatment are the cornerstones to success. Although different definitions for PJI have been used in the past, most are more or less similar and include the presence of a sinus tract, blood infection values, synovial white blood cell count, signs of infection on histopathological analysis and one or more positive culture results. Debridement, antibiotics and implant retention (DAIR) is the primary treatment for acute PJI, and should be performed as soon as possible after the development of symptoms. Success rates differ, but most studies report success rates of around 60%-80%. Whether single or multiple debridement procedures are more successful remains unclear. The use of local antibiotics in addition to the administration of systemic antibiotic agents is also subject to debate, and its pro's and con's should be carefully considered. Systemic treatment, based on culture results, is of importance for all PJI treatments. Additionally, rifampin should be given in Staphylococcal PJIs, unless all foreign material is removed. The most important factors contributing to treatment failure are longer duration of symptoms, a longer time after initial arthroplasty, the need for more debridement procedures, the retention of exchangeable components, and PJI caused by Staphylococcus (aureus or coagulase negative). If DAIR treatment is unsuccessful, the following treatment option should be based on the patient health status and his or her expectations. For the best functional outcome, one-or two-stage revision should be performed after DAIR failure. In conclusion, DAIR is the obvious choice for treatment of acute PJI, with good success rates in selected patients. Key words: Arthroplasty; Prosthesis; Infection; Periprosthetic joint infection; Retention; Debridement antibiotics and implant retention; Debridement; Acute Core tip: Acute periprosthetic joint infection (PJI) is a major complication after total joint arthroplasty, and occurs either postoperatively or via hematogenous spreading. Debridement, antibiotics and implant retention (DAIR), the primary treatment for acute PJI, should be performed as soon as possible after the development of symptoms, and has success rates around 60%-80%. Whether single or multiple debridement procedures are more successful remains unclear. Sys- REVIEW

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The Preoperative Prediction of Success Following Irrigation and Debridement With Polyethylene Exchange for Hip and Knee Prosthetic Joint Infections

Cited by 146 publications

References 33 publications

Prevention of Periprosthetic Joint Infection

Prevention of Periprosthetic Joint Infection

Tibial Tubercle Osteotomy or Quadriceps Snip in Two-stage Revision for Prosthetic Knee Infection? A Randomized Prospective Study

Treatment of acute periprosthetic infections with prosthesis retention: Review of current concepts

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