Abstract
Background
Irrigation and débridement (I&D), often with exchange of modular polyethylene components, is commonly used to treat acute periprosthetic infection (PPI) following total joint arthroplasty. Two-stage revision, the “Gold Standard” for PPIs' is more invasive, requires more resources, creating controversy over recommended initial treatment of PPIs. This study seeks to determine the success rate of an “intent to treat” approach utilizing I&Ds with progression to two stage revisions as required.
Methods
We retrospectively reviewed 5193 hip and knee joint arthroplasties performed over a 63 month period and identified 46 (20 female, 26 male, mean age 60) deep postoperative (within 365 days) infections that were initially managed with an “intention to treat and cure” I&D, with or without poly exchange. We investigated the overall success rate of this approach and the requirements for additional surgical procedures, as well other associated factors. 34 were managed with I&Ds only and 12 with two stage revisions as well.
Results
Infection eradication with implant retention was accomplished in 33 patients with I&Ds alone (72%). Of these, 25 required one I&D, 6 required 2 I&Ds and 2 required 3 I&Ds. 12 had 2-stage revisions, with 7 successes, 3 failures (1 each – amputation, fusion and infection recurrence after reimplantation) and 2 refusing revision of spacers. One had fusion after I&D without attempted staged revision. Thus, overall 40 of 46 (83%) were successfully managed after beginning with an “intent to treat” I&D and 33 of 46 (72%) patients avoided any surgeries other than I&Ds, thereby minimizing their cost, pain and morbidity.
Conclusions
This preliminary study, which will require further follow-up, appears to support beginning the treatment of selected acute postoperative infected arthroplasties with an initial I&D and then tailoring further treatments based on individual factors.
Level of Evidence This study was a retrospective comparative study, Level III evidence.
Key Words: IRRIGATION AND DEBRIDEMENT, I&D, PERIPROSTHETIC INFECTION, TWO STAGE REVISION, TOTAL HIP, TOTAL KNEE
