Irrigation and Debridement with Chronic Antibiotic Suppression Is as Effective as 2-Stage Exchange in Revision Total Knee Arthroplasty with Extensive Instrumentation
| Autor: | Michael B Geary, Susan M. Odum, Bryan D. Springer, Aldo M. Riesgo, Jeffrey J. Barry, Thomas K. Fehring |
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| Rok vydání: | 2020 |
| Předmět: |
Male
Reoperation medicine.medical_specialty Prosthesis-Related Infections Knee Joint medicine.drug_class medicine.medical_treatment Arthrodesis Antibiotics Periprosthetic 03 medical and health sciences 0302 clinical medicine medicine Humans Orthopedics and Sports Medicine 030212 general & internal medicine Stage (cooking) Arthroplasty Replacement Knee Therapeutic Irrigation Device Removal Aged Retrospective Studies Aged 80 and over 030222 orthopedics Debridement business.industry General Medicine Recovery of Function Middle Aged Surgery Anti-Bacterial Agents Treatment Outcome Female Level iii business Knee Prosthesis Revision total knee arthroplasty |
| Zdroj: | The Journal of bone and joint surgery. American volume. 103(1) |
| ISSN: | 1535-1386 |
| Popis: | Extraction of implants because of periprosthetic infection (PJI) following complex revision total knee arthroplasty (rTKA) with extensive instrumentation is a daunting undertaking for surgeon and patient alike. The purpose of the present study was to evaluate whether infections following complex rTKA are better treated with 2-stage exchange or irrigation and debridement (ID) with modular component exchange and antibiotic suppression in terms of infection control, reoperation, and function.We reviewed rTKAs that had been performed for the treatment of PJI from 2005 to 2016. Extensive instrumentation was defined as the presence ≥1 of the following: metaphyseal cones/sleeves, distal femoral replacement, periprosthetic fracture instrumentation, or fully cemented stems measuring75 mm. Cases were categorized according to the initial treatment (ID with antibiotic suppression or initiation of 2-stage exchange).Eighty-seven patients with PJI and extensive instrumentation were identified: 56 patients who were managed with ID with suppression and 31 who were managed with the initiation of 2-stage exchange. The rate of success (defined as no reoperation for infection) was similar for the 2 groups (62.5% the ID group compared with 67.7% for the 2-stage group; p = 0.62). The rate of mortality was also similar (39.3% for the ID group compared with 38.7% for the 2-stage group; p = 0.96). Of the 31 patients in the 2-stage group, 18 (58.1%) underwent reimplantation with a revision replacement. Of those 18 patients, 13 were still infection-free at the time of the most recent follow-up; however, when the analysis was expanded to all 31 patients in the 2-stage group, only 13 (41.9%) both had a successful reimplantation and did not require additional surgery for infection. Nine (29.0%) of the 31 patients in the 2-stage group never underwent the second stage, and 4 (12.9%) of the 31 required arthrodesis at the second stage. In contrast, 35 (62.5%) of the 56 patients in the ID group were successfully managed, without additional surgery for the treatment of infection. At the time of the latest follow-up (mean, 3.2 years; range, 2 to 13 years), more patients in the ID group were ambulatory (76.8% in the ID group compared with 54.8% in the 2-stage group; p = 0.05) and maintained a functional bending knee joint (85.7% in the ID group compared with 45.2% in the 2-stage group; p0.001).In the treatment of periprosthetic infection of rTKA with extensive instrumentation, ID with chronic antibiotic suppression was as effective as 2-stage exchange in terms of preventing reoperation for infection and was more effective in terms of maintaining function. These data apply to rTKA with extensive periarticular instrumentation and should not be extrapolated to primary or simple revision implants.Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. |
| Databáze: | OpenAIRE |
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