Irrigation and debridement correlated with a higher failure rate in patients with an acute hematogenous periprosthetic joint infection than in patients with an acute postsurgical periprosthetic joint infection, according to recently published results.
“The increase failure rate for [debridement and implant retention] DAIR performed for acute hematogenous infection may indicate that these patients may be manifesting an acute on chronic infection,” Javad Parvizi, MD, FRCS, told Healio.com/Orthopedics. “It is likely that some patients may have had a chronic subclinical infection that is then exacerbated by a second event, leading to clinical infection. Some of these cases, thus, are not truly acute infections and it is not a surprise that DAIR fails for some of these patients.”
Researchers retrospectively reviewed 199 total joint arthroplasty patients who underwent irrigation and debridement for acute postsurgical periprosthetic joint infection (PJI) or acute hematogenous PJI between 2006 and 2016. Investigators identified patient demographics, comorbidities, physical examination findings, laboratory results and organism profile.
Results showed that at 1 year, the failure rate was 37.7%. The failure rate for patients with acute hematogenous PJI was twice that of patients with acute postsurgical PJI (56% vs. 31%). Investigators noted prior revision surgery and a higher Charlson Comorbidity Index were among the host predictors of failure. Chronic obstructive pulmonary disease, diabetes and a history of malignancy were among the specific comorbidities correlated with failure.
Treatment failure after irrigation and debridement was seen more in patients with polymicrobial infections. The presence of intraoperative purulence, elevated systolic blood pressure, tachycardia and a high serum C-reactive protein level were among the clinical and laboratory risk factors correlated with failure. – by Monica Jaramillo
Disclosures: The authors report no relevant financial disclosures.