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01.01.2011 | Symposium: Papers Presented at the Annual Meetings of the Knee Society | Ausgabe 1/2011

Clinical Orthopaedics and Related Research® 1/2011

The Chitranjan Ranawat Award: Fate of Two-stage Reimplantation After Failed Irrigation and Débridement for Periprosthetic Knee Infection

Zeitschrift:
Clinical Orthopaedics and Related Research® > Ausgabe 1/2011
Autoren:
MD J. Christopher Sherrell, MD Thomas K. Fehring, MEd Susan Odum, MD Erik Hansen, BS Benjamin Zmistowski, BS Anne Dennos, MD Niraj Kalore, the Periprosthetic Infection Consortium
Wichtige Hinweise
Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained as necessary.
Data were collected at each institution. Data analysis was conducted at OrthoCarolina Research Institute.
The members of the Periprosthetic Infection Consortium include Kevin Bozic, MD; Craig Della Valle, MD; Terence Gioe, MD; Javad Parvizi, MD; Bryan D. Springer, MD; Thomas K. Fehring, MD; and Susan Odum, MEd.

Abstract

Background

Irrigation and débridement is an attractive low morbidity solution for acute periprosthetic knee infection. However, the failure rate in the literature is high, averaging 68% (range, 61%–82%). Patients who fail subsequently undergo two-stage reimplantation after a prolonged period of illness. This leads to higher surgical risk and further delays in rehabilitation and may contribute to failure of subsequent revision surgery.

Questions/purposes

We determined the rerevision rate due to infection after two-stage reimplantation performed for failed irrigation and débridement of infected TKA.

Methods

We performed a multicenter retrospective review of periprosthetic knee infections treated with a two-stage procedure from 1994 to 2008. Selection criteria for the study included initial treatment with irrigation and débridement and subsequent two-stage revision surgery. Failure of two-stage revision was defined as the need for any additional surgery due to infection.

Results

Of the 83 knees that had undergone previous irrigation and débridement, 28 (34%) failed subsequent two-stage revision and required reoperation for persistent infection.

Conclusions

The failure rate in this series of two-stage revisions for periprosthetic knee infection in patients treated with previous irrigation and débridement is considerably higher than previously reported failure rates of two-stage revision. Factors affecting the failure rate may include host quality, thoroughness of débridement, and organism virulence. Patients and surgeons must understand that irrigation and débridement, while initially attractive, may lead to high failure rates of subsequent two-stage reimplantation.

Level of Evidence

Level III, therapeutic study. See the guidelines online for a complete description of level of evidence.

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