A Multicenter Study of Irrigation and Debridement in Total Knee Arthroplasty Periprosthetic Joint Infection: Treatment Failure Is High

• Published in: The Journal of arthroplasty 2018-04, Vol.33 (4), p.1154-1159
• Main Authors: Urish, Kenneth L., Bullock, Andrew G., Kreger, Alexander M., Shah, Neel B., Jeong, Kwonho, Rothenberger, Scott D., Irrgang, James J., Klatt, Brian A., Hamlin, Brian R.
• Format: Article
• Language: English
• Subjects: Aged; Anti-Bacterial Agents - therapeutic use; Arthroplasty, Replacement, Knee - adverse effects; cohort study; DAIR (debridement, antibiotics, and implant retention); Debridement - methods; Female; Humans; irrigation and debridement; Level III; Male; Middle Aged; outcomes; periprosthetic joint infection; Prosthesis-Related Infections - etiology; Prosthesis-Related Infections - surgery; Retrospective Studies; Therapeutic Irrigation; total knee arthroplasty; Treatment Failure
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/j.arth.2017.11.029

In total knee arthroplasty (TKA) periprosthetic joint infection (PJI), irrigation and debridement (I&D) with component retention is a treatment option with a wide variation in reported failure rates. The purpose of this study was to determine failure rates, outcomes, and factors that predict failure in I&D for TKA PJI. A multicenter observational study of patients with a TKA PJI and subsequently undergoing an I&D with retention of components was conducted. The primary outcome was failure rate of I&D, where failure was defined as any subsequent surgical procedures. Two hundred sixteen cases of I&D with retention of components performed on 206 patients met inclusion criteria. The estimated long-term failure rate at 4 years was 57.4%. Time-to-event analyses revealed that the median survival time was 14.32 months. Five-year mortality was 19.9%. Multivariable modeling revealed that time symptomatic and organism were independent predictors of I&D failure. Culture-negative status had a higher hazard for failure than culture-positive patients. When primary organism and time symptomatic were selected to produce an optimized scenario for an I&D, the estimated failure rate was 39.6%. I&D with retention of components has a high failure rate, and there is a high incidence of more complex procedures after this option is chosen. The patient comorbidities we investigated did not predict I&D success. Our results suggest that I&D has a limited ability to control infection in TKA and should be used selectively under optimum conditions.