AGGRESSIVE EARLY DEBRIDEMENT CAN BE SUCCESSFUL FOR INFECTED TOTAL KNEE ARTHROPLASTY

Abstract

Introduction: Up to 2% of total knee arthroplasties (TKA) are still complicated by infection. This leads to dissatisfied patients with poor function, and has far-reaching social and economic consequences. The challenge in these cases is the eradication of infection, the restoration of full function and the prevention of recurrence. We report the outcome of prosthesis sparing early aggressive debridement in the acutely infected TKA.

Methods: We studied 29 consecutive patients referred with acutely infected TKA (18 primaries, 11 revisions) which occurred within 6 weeks of the index operation or of haematogenous spread. Microbiology confirmed bacterial colonization in all cases with 20 early postoperative infections and 9 cases of acute haematogenous spread. All patients underwent aggressive open debridement, a thorough synovectomy and a change of insert. Antibiotics were continued until inflammatory markers and the plasma albumin concentration returned to within normal limits.

Results: Three patients required multiple washouts. 8 patients needed a two stage revision. 21 patients returned to their expected functional level without removal of the implants and with no radiographic evidence of prosthetic failure. At a minimum 2 years follow-up, we had a 72% infection control rate. The outcome was significantly better in patients treated in the first 120 hours after presentation.

Discussion and Conclusion: Our data suggests that there is a role for early aggressive open debridement in acute infections after TKA with an excellent chance of prosthesis salvage.