A Multicenter Study of Irrigation and Debridement in Total Knee Arthroplasty Periprosthetic Joint Infection: Treatment Failure Is High
Kenneth L Urish, Andrew G Bullock, Alexander M Kreger, Neel B Shah, Kwonho Jeong, Scott D Rothenberger, Infected Implant Consortium, James J Irrgang, Brian A Klatt, Brian R Hamlin, Kenneth L Urish, Andrew G Bullock, Alexander M Kreger, Neel B Shah, Kwonho Jeong, Scott D Rothenberger, Infected Implant Consortium, James J Irrgang, Brian A Klatt, Brian R Hamlin
Abstract
Background: 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.
Methods: 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.
Results: 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%.
Conclusion: 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.
Keywords: DAIR (debridement, antibiotics, and implant retention); Level III; cohort study; irrigation and debridement; outcomes; periprosthetic joint infection; total knee arthroplasty.
Copyright © 2017 Elsevier Inc. All rights reserved.
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Source: PubMed