Efficacy of Open Debridement and Polyethylene Exchange in Strictly Selected Patients with Infection after Total Knee Arthroplasty

Abstract

Purpose: To assess the efficacy of open debridement and polyethylene exchange (ODPE) combined with proper antibiotic therapy in strictly selected patients with infection after total knee arthroplasty (TKA) and analyze factors associated with treatment failure.

Materials and methods: From January 2010 to January 2014, 25 cases that underwent ODPE under the diagnosis of infection within four weeks after TKA or acute hematogenous infection within five days of symptom onset were reviewed in this study.

Results: Treatment was successful in 22 out of 25 cases (88.0%). Factors associated with failure were accompanying infection (periprosthetic infection in the ipsilateral foot, cervical parotid abscess, and masticator space abscess) and diagnosis of rheumatoid arthritis (RA) before TKA. Resistant bacteria did not entail a risk. On clinical results, the mean postoperative Lysholm score and Korean Knee score were 81.4 and 79.4, respectively, the knee range of motion was 115.4°±12.9°, and duration of hospitalization was 32.3±8.4 days. On radiographic results, 3.47±1.56 mm joint line elevation and a valgus change of 0.61°±2.35° in knee alignment were observed.

Conclusions: ODPE combined with appropriate antibiotics therapy could be a useful treatment method for infection after TKA if the procedure is performed within a symptom duration of five days or less in the absence of accompanying infection in patients whose indication for TKA was not RA.

Keywords: Arthroplasty; Debridement; Infection; Knee.

Fig. 1

Intraoperative photographs showing complete synovectomy to the posterior capsule with polyethylene removed.

Fig. 2

Preoperative anteroposterior radiograph (A) and intraoperative photograph (B) showing periprosthetic infection in the ipsilateral foot in a treatment failure case.

Fig. 3

Computed tomography of the neck showing accompanying cervical parotid abscess and masticator space abscess in a treatment failure case.

Fig. 4

Preoperative anteroposterior (A) and lateral (B) radiographs showing a constrained type component and internal fixation due to previous periprosthetic fracture in a treatment failure case.