Failure of Irrigation and D,bridement for Early Postoperative Periprosthetic Infection

被引:144
作者
Fehring, Thomas K. [1 ]
Odum, Susan M. [2 ]
Berend, Keith R. [3 ]
Jiranek, William A. [4 ]
Parvizi, Javad [5 ]
Bozic, Kevin J. [6 ]
Della Valle, Craig J. [7 ]
Gioe, Terence J. [8 ]
机构
[1] OrthoCarolina PA, Hip & Knee Ctr, Charlotte, NC 28207 USA
[2] OrthoCarolina Res Inst Inc, Charlotte, NC USA
[3] Joint Implant Surg Inc, New Albany, OH USA
[4] Virginia Commonwealth Univ, Dept Orthopaed Surg, Richmond, VA USA
[5] Rothman Inst, Philadelphia, PA USA
[6] Univ Calif San Francisco, Dept Orthopaed Surg, San Francisco, CA 94143 USA
[7] Rush Univ, Med Ctr, Chicago, IL 60612 USA
[8] Minneapolis Vet Affairs Med Ctr, Dept Orthopaed Surg, Minneapolis, MN USA
关键词
TOTAL KNEE ARTHROPLASTY; PROSTHETIC JOINT INFECTIONS; TOTAL HIP-ARTHROPLASTY; OPEN DEBRIDEMENT; RETENTION; COMPONENTS; BIOFILMS;
D O I
10.1007/s11999-012-2373-9
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
100224 [整形外科学];
摘要
Irrigation and d,bridement (I&D) of periprosthetic infection (PPI) is associated with infection control ranging from 16% to 47%. Mitigating factors include organism type, host factors, and timing of intervention. While the influence of organism type and host factors has been clarified, the timing of intervention remains unclear. We addressed the following questions: What is the failure rate of I&Ds performed within 90 days of primary surgery? And what factors are associated with failure? We performed a multicenter retrospective analysis of I&D for PPI within 90 days of primary surgery. We included 86 patients (44 males, 42 females) with an average age of 61 years. Failure was defined as return to the operating room for an infection-related problem. We determined the failure rate of I&D within 90 days of primary surgery and whether the odds of rerevision for infection were associated with Charlson Comorbidity Index, age, sex, joint, organism type, and timing. The minimum followup was 24 months (average, 46 months; range, 24-106 months). 54 of 86 patients (63%) failed. Eight of 10 (80%) failed within the first 10 days, 32 of 57 (56%) within 4 weeks, and 22 of 29 (76%) within 31 to 90 days postoperatively. No covariates were associated with subsequent revision surgery for infection. I&D for PPI is frequently used in the early postoperative period to control infection. While it is assumed early intervention will lead to control of infection in most cases, our data contradict this assumption. Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
引用
收藏
页码:250 / 257
页数:8
相关论文
共 43 条
[1]
Treatment of staphylococcal prosthetic joint infections with debridement, prosthesis retention and oral rifampicin and fusidic acid [J].
Aboltins, C. A. ;
Page, M. A. ;
Buising, K. L. ;
Jenney, A. W. J. ;
Daffy, J. R. ;
Choong, P. F. M. ;
Stanley, P. A. .
CLINICAL MICROBIOLOGY AND INFECTION, 2007, 13 (06) :586-591
[2]
Irrigation and Debridement in the Management of Prosthetic Joint Infection: Traditional Indications Revisited [J].
Azzam, Khalid A. ;
Seeley, Mark ;
Ghanem, Elie ;
Austin, Matthew S. ;
Purtill, James J. ;
Parvizi, Javad .
JOURNAL OF ARTHROPLASTY, 2010, 25 (07) :1022-1027
[3]
Metabolic Differentiation in Biofilms as Indicated by Carbon Dioxide Production Rates [J].
Bester, Elanna ;
Kroukamp, Otini ;
Wolfaardt, Gideon M. ;
Boonzaaier, Leandro ;
Liss, Steven N. .
APPLIED AND ENVIRONMENTAL MICROBIOLOGY, 2010, 76 (04) :1189-1197
[4]
The Fate of Acute Methicillin-Resistant Staphylococcus aureus Periprosthetic Knee Infections Treated by Open Debridement and Retention of Components [J].
Bradbury, Thomas ;
Fehring, Thomas K. ;
Taunton, Michael ;
Hanssen, Arlen ;
Azzam, Khalid ;
Parvizi, Javad ;
Odum, Susan M. .
JOURNAL OF ARTHROPLASTY, 2009, 24 (06) :101-104
[5]
Staphylococcus aureus prosthetic joint infection treated with debridement and prosthesis retention [J].
Brandt, CM ;
Sistrunk, WW ;
Duffy, MC ;
Hanssen, AD ;
Steckelberg, JM ;
Ilstrup, DM ;
Osmon, DR .
CLINICAL INFECTIOUS DISEASES, 1997, 24 (05) :914-919
[6]
BURGER RR, 1991, CLIN ORTHOP RELAT R, P105
[7]
Can Implant Retention be Recommended for Treatment of Infected TKA? [J].
Choi, Ho-Rim ;
von Knoch, Fabian ;
Zurakowski, David ;
Nelson, Sandra B. ;
Malchau, Henrik .
CLINICAL ORTHOPAEDICS AND RELATED RESEARCH, 2011, 469 (04) :961-969
[8]
Bacterial biofilms: A common cause of persistent infections [J].
Costerton, JW ;
Stewart, PS ;
Greenberg, EP .
SCIENCE, 1999, 284 (5418) :1318-1322
[9]
Costerton JW, 1984, REV INFECT DIS S3, V6, pS608
[10]
Treatment of infection with debridement and retention of the components following hip arthroplasty [J].
Crockarell, JR ;
Hanssen, AD ;
Osmon, DR ;
Morrey, BF .
JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME, 1998, 80A (09) :1306-1313