Irrigation and debridement with chronic antibiotic suppression for the management of infected total knee arthroplasty
Autor: | Daniel J. Berry, Matthew P. Abdel, J T Weston, Tad M. Mabry, Chad D. Watts, Arlen D. Hanssen |
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Rok vydání: | 2018 |
Předmět: |
Male
medicine.medical_specialty Prosthesis-Related Infections medicine.drug_class medicine.medical_treatment Antibiotics Total knee arthroplasty Administration Oral Drug Administration Schedule Total knee 03 medical and health sciences 0302 clinical medicine Risk Factors medicine Humans Orthopedics and Sports Medicine 030212 general & internal medicine Arthroplasty Replacement Knee Infusions Intravenous Therapeutic Irrigation Aged Retrospective Studies 030222 orthopedics Debridement business.industry Prosthetic joint infection Middle Aged Combined Modality Therapy Anti-Bacterial Agents Prosthesis Failure Surgery Acute Disease Female Knee Prosthesis business Follow-Up Studies |
Zdroj: | The Bone & Joint Journal. :1471-1476 |
ISSN: | 2049-4408 2049-4394 |
DOI: | 10.1302/0301-620x.100b11.bjj-2018-0515.r1 |
Popis: | AimsThe results of irrigation and debridement with component retention (IDCR) in the treatment of acutely infected total knee arthroplasties (TKAs) have been variable. The aim of this study was to assess the outcome after IDCR when combined with chronic antibiotic suppression. We also evaluated survivorship free from subsequent infection, removal of the components, and death, as well as the risk factors for failure.Patients and MethodsThis was a single-centre retrospective review of 134 infected primary TKAs that were treated with IDCR. Infections within four weeks of the procedure were defined as acute postoperative infections, and those occurring more than four weeks after the procedure with symptoms for less than three weeks were defined as acute haematogenous infections. Patients were treated with intravenous antibiotics for four to six weeks, followed by chronic oral antibiotic suppression. Estimates of survival were made using a competing risk analysis. The mean follow-up was five years (2.1 to 13).ResultsThe infection was an acute postoperative infection in 23 TKAs and an acute haematogenous infection in 111 TKAs. The incidence of subsequent infection was 36% in those with an acute postoperative infection and 33% in those with a haematogenous infection, five years postoperatively (p = 0.40). Age < 60 years increased the risk of subsequent infection (hazard ratio (HR) 2.4; p = 0.009) and removal of the components (HR 2.8; p = 0.007). Infection with a staphylococcal species increased the risk of subsequent infection (HR 3.6; p < 0.001), and removal of the components (HR 3.2; p = 0.002). Musculoskeletal Infection Society host type and local extremity grade, body mass index (BMI), the duration of symptoms, gender, and the presence of a monoblock tibial component had no significant effect on the outcome.ConclusionIn a rigorously defined group of acute periprosthetic infections after TKA treated with IDCR and chronic antibiotic suppression, the infection-free survival at five years was 66%. The greatest risk factor for failure was an infection with a staphylococcal species, followed by age of < 60 years. Cite this article: Bone Joint J 2018;100-B:1471–76. |
Databáze: | OpenAIRE |
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