PRAGUE — Irrigation and debridement for the treatment of hip and knee periprosthetic joint infections is a reasonable option for selected patients and should be performed within a short interval for these patients, according to study results presented here.
“Irrigation and debridement for early postoperative and hematogenous infections is related to unfavorable outcomes in patients with obesity for total hip arthroplasty, thyroid disease for total knee arthroplasty, duration of symptoms of more than 5 days for both and infection with methicillin-resistant Staphylococci for both,” Georgios K. Triantafyllopoulos, MD, said at the EFORT Congress.
In a retrospective study, Triantafyllopoulos and colleagues reviewed the clinical characteristics of patients who were diagnosed with early postoperative or hematogenous hip and knee periprosthetic joint infections (PJI) and were treated with single or multiple irrigation and debridement procedures between January 2000 and December 2013. Researchers recorded demographics, infection site and type, duration of symptoms, time from index procedure to irrigation and debridement, pathogen type, comorbidity, interval between serial irrigation and debridements, C-reactive protein levels and erythrocyte sedimentation rates. The minimum follow-up was 12 months. The researchers identified 154 patients with hip and knee (60
hips and 94 knees) PJI. Mean patient age was 64.3 years.
Georgios K. Triantafyllopoulos
For patients with hip PJI, the success rate of irrigation and debridement was 70%. Researchers found obesity (BMI=30) correlated with failure. Patients who had MRSA infections had 96% lower odds of success compared with patients who had non-Staphylococcal gram positive, gram negative bacteria or negative cultures. Patients with duration of symptoms greater than 5 days had 95.2% lower odds of success. The probability of implant retention decreased by 15.7% for each additional day of symptoms.
For patients with knee PJI, the success rate of irrigation and debridement was 55.3%. Researchers found thyroid disease and duration of symptoms were independent risk factors. Patients with MRSA infections had 96.8% lower rate of success compared with PJI with negative cultures. Patients with duration of symptoms greater than 5 days had 94.6% lower odds of success. The probability of implant retention decreased by 7.5% for each additional day of symptoms.
Overall, 23 patients (11 hips and 12 knees) were treated with second or third irrigation and debridement procedures. Implant retention was achieved in 10 patients. Triantafyllopoulous said that intervals of more than 20 days between the first and second irrigation and debridement procedures were associated with 97.4% lower odds of success. Additionally, patients who had multiple irrigation and debridement also had a higher prevalence of peripheral arterial disease. – by Kristine Houck, MA, ELS
Reference: Triantafyllopoulos GK. Paper #3582. Presented at the EFORT Congress; May 27-29 2015; Prague.
Disclosure: Triantafyllopoulos reports no relevant financial disclosures.