PERIPROSTHETIC INFECTION: DOES IRRIGATION AND DEBRIDEMENT WORK?

Abstract

Debridement of an infected total joint arthroplasty with retention of mechanically stable components is often performed for acute cases of periprosthetic infection (PPI). However, the reported success of such a procedure to fully eradicate infection has varied widely. The objective of this study was to elucidate the efficacy of debridement in both infected THA and TKA and attempt to identify risk factors responsible for failure.

During the years 2000–2005, 71 TKA and 69 THA underwent irrigation and debridement for acute PPI (< 4 weeks). All patients were followed up prospectively for at least two years. Detailed data including demographics, comorbidities, surgical history, and medication intake was collected. Intraoperative data, organism profile, and complications were also documented. Failure was defined as patient requiring additional surgical procedure for control of infection or loosening.

Of the 140 patients, 24% required repeat irrigation and debridement for postoperative drainage, hema-toma formation, or systemic symptoms. One third of these revision debridement patients underwent multiple consecutive debridements. Two-stage resection arthroplasty was required in 65 patients (46%) of the entire cohort. Fifty-eight percent of the patients with resection required revision of their cement spacer block due to continuous drainage and systemic symptoms indicative of persistent infection. We noted a total of 86 failures (61%) that required either an additional debridement or resection arthroplasty after the first debridement procedure. The failure rates of THA (62%) and TKA (55%) individually were similar (p=0.253).

Although the concept of conservative management of PPI with debridement and retention of components is an attractive alternative to resection arthroplasty, we have found that 60% of patients undergoing this procedure will inevitably undergo two-stage arthroplasty. Furthermore, more than half of the patients that required resection arthroplasty developed infection of their spacer that entailed revision of the cement block. Therefore, we can conclude that this procedure has a high failure rate and should be implemented in only a select group of patients.