IRRIGATION-SUCTION DRAINAGE IN THE TREATMENT OF INFECTED JOINTS AND JOINT ARTHROPLASTIES – THE STATE OF THE ART?

Abstract

Aim of the study: Joint infection and infection of arthroplasty is a severe problem and its treatment controversial. Treatment with irrigation-suction-drain is still common. We investigated the outcome of this method.

Patients and method: In a retrospective trial, 129 patients with infection of the hip-, knee- and shoulder joint were included. 28 of these patients had an infected hip, knee or shoulder prosthesis.

The mean follow up was 5 years. Patients with rheumatic disease, tumors or patients under immunosuppressive therapy were excluded. Infectious disease consultants supervised the administration of intravenous antibiotics. No antibiotics were added to the irrigating solution.

Results: In 44, 6% of the patient group with septic arthritis the infection could not be eradicated with open surgical debridement and irrigation-suction drainage treatment. In the arthroplasty group 39, 3% were not cured. In total 55 patients underwent additional surgery once or several times to get the infection under control. In 9 of the 28 patient with arthroplasty, the prosthesis had to be removed. The predominant infectious organisms were gram-positive (Staphylococcus epidermidis, Staphylococcus aureus and Streptococcus Group B). Three percent of the knees that were infected clinically had no organisms that could be identified. In 78, 2% of the patients who had additional surgery the antibiogram showed a change in the resistance or/and a change of the pathogen microorganism. Four patients developed a MRSA. The mean duration in the hospital stay was 36 days.

Conclusion: The treatment with irrigation-suction-drain is not recommended according to these results. Other methods like debridement and local antibiotics in combination with systemic antibiotics seams to be more effective according to the literature. Even the duration of the hospital stay is shorter with other methods. The high rate of microorganism changes and changes in the resistance of the microorganism is not acceptable.