Irrigation and débridement and prosthesis retention for treating acute periprosthetic infections

Abstract

Background: Infections following hip and knee replacements can compromise the function and durability of arthroplasty. When these infections occur during the immediate postoperative period, irrigation and débridement can be attempted to salvage the implant. Prior studies have reported varying results likely due to lack of consistent inclusion criteria, variations in surgical technique, and lack of uniform treatment protocols.

Questions/purposes: To supplement this literature we determined the rate at which irrigation and débridement and prosthesis retention would control acute periprosthetic infections.

Methods: We retrospectively reviewed the medical records of 18 patients with acute periprosthetic infections occurring within 28 days after 13 THAs and 5 TKAs. The mean time to reoperation was 19 days (range, 6-28 days) after arthroplasty. Superficial débridements were performed in five cases, and a polyethylene or ball head exchange was performed in the remaining 13 cases when fascial defects were encountered at the time of surgery.

Results: We salvaged the prosthesis in four of five patients with superficial irrigation and débridement group and eight of 13 with deep infections. Intraoperative cultures were positive in 83% of cases (n = 15). Five patients (one superficial and four deep) eventually underwent resection arthroplasty. Three patients underwent repeat irrigation and débridement, and one of these three ultimately had resection arthroplasty. Polymicrobial infections were detected in four cases, all failures. The average time to resection was 62 days (range, 12-134 days).

Conclusions: Consistent with the literature, success of prosthesis salvage for periprosthetic infections occurring within 28 days after arthroplasty depends on the location, extent, and microbiology of the infection.

Level of evidence: Level IV, case series. See the Guidelines for Authors for a complete description of levels of evidence.