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Acceptable Success Rate in Patients With Periprosthetic Knee Joint Infection Treated With Debridement, Antibiotics, and Implant Retention.
J Arthroplasty 2019; 34(2):365-368JA

Abstract

BACKGROUND

Acute periprosthetic joint infection (PJI) following primary total knee arthroplasty (TKA) surgery can be treated with debridement, antibiotics, and implant retention (DAIR). However, varying results have been reported in the literature and optimal timing of the procedure is still debated. In this retrospective cohort study, we investigate (a) success rate of DAIR for treating PJI following primary TKA surgery and (b) whether time after primary surgery until DAIR and (c) type of isolated microorganism influence outcome.

METHODS

Sixty-seven patients with PJI following primary TKA surgery treated with DAIR were identified. Patients with insufficient data and patients who did not fulfill Musculoskeletal Infection Society PJI criteria were excluded, leaving 58 patients for analysis. Minimum follow-up was 2 years. A DAIR was considered a success if the patient was infection free after 2 years.

RESULTS

The overall success rate of PJI treated with DAIR was 84%. Median time until DAIR was 21 days (7-1092). Thirty-four patients (59%) were revised within 28 days, 42 patients (72%) within 42 days, while 10 patients (17%) were revised more than 90 days after primary TKA surgery. The success rates were 85%, 88%, and 60%, respectively. In the patients revised within 90 days, our success rate was 90% (43/48) regardless of the involved microorganism.

CONCLUSION

We find DAIR to be a viable and safe treatment option for PJI following primary TKA surgery, when performed early after primary surgery and with the addition of a relevant postrevision antibiotic regime.

Authors+Show Affiliations

Department of Orthopedic Surgery, Copenhagen University Hospital, Copenhagen, Denmark.Department of Orthopedic Surgery, Copenhagen University Hospital, Copenhagen, Denmark.Department of Orthopedic Surgery, Copenhagen University Hospital, Copenhagen, Denmark.Department of Orthopedic Surgery, Copenhagen University Hospital, Copenhagen, Denmark.Department of Orthopedic Surgery, Copenhagen University Hospital, Copenhagen, Denmark.Department of Orthopedic Surgery, Copenhagen University Hospital, Copenhagen, Denmark.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30401558

Citation

Ottesen, Casper S., et al. "Acceptable Success Rate in Patients With Periprosthetic Knee Joint Infection Treated With Debridement, Antibiotics, and Implant Retention." The Journal of Arthroplasty, vol. 34, no. 2, 2019, pp. 365-368.
Ottesen CS, Troelsen A, Sandholdt H, et al. Acceptable Success Rate in Patients With Periprosthetic Knee Joint Infection Treated With Debridement, Antibiotics, and Implant Retention. J Arthroplasty. 2019;34(2):365-368.
Ottesen, C. S., Troelsen, A., Sandholdt, H., Jacobsen, S., Husted, H., & Gromov, K. (2019). Acceptable Success Rate in Patients With Periprosthetic Knee Joint Infection Treated With Debridement, Antibiotics, and Implant Retention. The Journal of Arthroplasty, 34(2), pp. 365-368. doi:10.1016/j.arth.2018.09.088.
Ottesen CS, et al. Acceptable Success Rate in Patients With Periprosthetic Knee Joint Infection Treated With Debridement, Antibiotics, and Implant Retention. J Arthroplasty. 2019;34(2):365-368. PubMed PMID: 30401558.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Acceptable Success Rate in Patients With Periprosthetic Knee Joint Infection Treated With Debridement, Antibiotics, and Implant Retention. AU - Ottesen,Casper S, AU - Troelsen,Anders, AU - Sandholdt,Håkon, AU - Jacobsen,Steffen, AU - Husted,Henrik, AU - Gromov,Kirill, Y1 - 2018/10/09/ PY - 2018/05/23/received PY - 2018/09/25/revised PY - 2018/09/26/accepted PY - 2018/11/8/pubmed PY - 2019/5/18/medline PY - 2018/11/8/entrez KW - Acute periprosthetic joint infection KW - debridement KW - prosthesis retention KW - revision knee arthroplasty KW - timing SP - 365 EP - 368 JF - The Journal of arthroplasty JO - J Arthroplasty VL - 34 IS - 2 N2 - BACKGROUND: Acute periprosthetic joint infection (PJI) following primary total knee arthroplasty (TKA) surgery can be treated with debridement, antibiotics, and implant retention (DAIR). However, varying results have been reported in the literature and optimal timing of the procedure is still debated. In this retrospective cohort study, we investigate (a) success rate of DAIR for treating PJI following primary TKA surgery and (b) whether time after primary surgery until DAIR and (c) type of isolated microorganism influence outcome. METHODS: Sixty-seven patients with PJI following primary TKA surgery treated with DAIR were identified. Patients with insufficient data and patients who did not fulfill Musculoskeletal Infection Society PJI criteria were excluded, leaving 58 patients for analysis. Minimum follow-up was 2 years. A DAIR was considered a success if the patient was infection free after 2 years. RESULTS: The overall success rate of PJI treated with DAIR was 84%. Median time until DAIR was 21 days (7-1092). Thirty-four patients (59%) were revised within 28 days, 42 patients (72%) within 42 days, while 10 patients (17%) were revised more than 90 days after primary TKA surgery. The success rates were 85%, 88%, and 60%, respectively. In the patients revised within 90 days, our success rate was 90% (43/48) regardless of the involved microorganism. CONCLUSION: We find DAIR to be a viable and safe treatment option for PJI following primary TKA surgery, when performed early after primary surgery and with the addition of a relevant postrevision antibiotic regime. SN - 1532-8406 UR - https://www.unboundmedicine.com/medline/citation/30401558/Acceptable_Success_Rate_in_Patients_With_Periprosthetic_Knee_Joint_Infection_Treated_With_Debridement_Antibiotics_and_Implant_Retention_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0883-5403(18)30871-4 DB - PRIME DP - Unbound Medicine ER -