Authors: Van Kleunen JP, Knox D, Garino JP, Lee GC, University of Pennsylvania, Philadelphia, PA
Title: Success Rates of Irrigation and Debridement (I+D) and Prosthesis Retention for Treatment of Acute Deep Prosthetic Infections
Purpose: Acute prosthetic infections may bedefined as those occurring within 90 days following joint implantation. The purpose of this study is to evaluate the success rates of I+D and prosthetic retention for treatment of acute deep prosthetic infections.
Methods: We retrospectively reviewed 29 hips and knees with acute deep prosthetic infections following THA and TKA performed by a single surgeon. There were 17 men and 12 women with an average age of 55.6 years at the time of the I+D. There were 12 TKA and 17 THA and the mean time to irrigation and debridement was 32.3 days (range 6-82) following the preceding arthroplasty. An arthrotomy was performed in all knees, and a polyethylene exchange was performed in 8 cases. A superficial I+D was performed in 8 hips while an arthrotomy was performed in the remaining cases. Patients received culture specific intravenous antibiotics for a minimum of 6 weeks postoperatively when appropriate.
Results: Intraoperative cultures were positive in 23 cases. The most common organism was methicillin-sensitive S. aureus followed by coagulase-negative Staphlococcus and methicillin-resistant S. aureus, respectively. Five patients had polymicrobial infections. Following 6 weeks of IV antibiotics, 8 patients required a repeat I+D, and 9 patients eventually required prosthesis explantation. Resection arthroplasty was performed at a mean of 101.1 days after the I+D (range 12-234). All prostheses that required resection had positive intraoperative cultures at the time of the I+D. Overall, the rate of prosthesis salvage was 69.0 percent.
Discuassion and Conclusion: Success rates for prosthesis salvage for acute deep prosthetic infection in our series was higher than those traditionally reported. Possible reasons for increased successes can be attributed to improved early detection of infections and aggressive I+D. While strict criteria should be applied when considering prosthesis retention for acute postoperative infections, early detection and a thorough washout may prevent resection.
