Aggressive Early Debridement in Treatment of Acute Periprosthetic Joint Infections After Hip and Knee Replacements

Abstract

Background:Periprosthetic Joint Infection Remains a Dreaded Complication After Hip and Knee Replacement Surgery.Treatment Options for Acute Postoperative and Acute Hematogenous Infections Include Arthroscopic or Open Debridement With Retention or Exchange of the Prostheses. This Review Article Aims to Summarize the Evidence for Management of Acute Postoperative And Acute Hematogenous Infections.Methods:A Systematic Literature Search Was Performed Using a Computer-based Search Engine Covering Medline (OvidSP), PubMed Database (U.S. National Library of Medicine, National Institutes of Health), Embase, Web of Science, Cochrane and Google Scholar for Relevant Articles.Results:Common Themes Around Treatment of Acute Postoperative and Acute Hematogenous Infections Discussed in this Review Include the Timing of Intervention, Description of the Optimal Procedure and How we Perform it at our Institution, the Role of Arthroscopic Debridement, Most Commonly Isolated Micro-organisms and Prognostic Factors for Infection Control.Conclusion:Success in Treating Acute Postoperative and Acute Hematogenous Infections Depends on Early Diagnosis and Aggressive Surgical Debridement Combined With Effective Antibiotic Therapy.

One-year infection control rates of a DAIR (debridement, antibiotics and implant retention) procedure after primary and prosthetic-joint-infection-related revision arthroplasty – a retrospective cohort study

“…Most of our infection control rates of DAIR procedures are comparable to the overall pooled success rate of 61.4 % reported in a recent meta-analysis (Kunutsor et al, 2018). However, some other retrospective studies have reported higher infection control rates for DAIR procedures (Byren et al, 2009;Sendi et al, 2017;Volpin et al, 2016;Wouthuyzen-Bakker et al, 2020). The relatively large number of patients a S. capitis (n = 2), S. warneri (n = 1), S. haemolyticus (n = 1) and S. pseudintermedius (n = 1).…”

“…Nonetheless, even more than 6 weeks after the index arthroplasty an eradication rate of 60 % can be achieved when performing DAIR (Löwik et al, 2019). The success rate of DAIR for early postoperative infection is better than for hematogenous infections (Volpin et al, 2016;Wouthuyzen-Bakker et al, 2020). There is no place for DAIR in the treatment of chronic infections (Sukeik and Haddad, 2019).…”

Periprosthetic joint infections after total hip replacement: an algorithmic approach

“…in a previously well-functioning implant [12,14,15]. In haematogenous infections, a full workup to establish the source of infection should be undertaken preoperatively, including a comprehensive history of recent systemic infections or invasive procedures causing bacteremic seeding of the hip, and investigations should include a throat swab, chest radiograph, and urine, stool and blood cultures [14].…”

“…An aggressive open debridement with exchange of mobile parts and retention of the implant in stable components with no evidence of immunosuppression, and overlying soft tissue and skin of good condition is associated with good results of infection control, especially when the infection is diagnosed within the first week after the index procedure [13][14][15]17,18]. The aim of rapid intervention with thorough open debridement is to prevent the production of any biofilm by the infecting organism, paramount for successful treatment of infection [7,19].…”

“…The aim of rapid intervention with thorough open debridement is to prevent the production of any biofilm by the infecting organism, paramount for successful treatment of infection [7,19]. Patients undergo an open complete synovectomy, multiple tissue sampling, exchange of femoral heads and acetabular inserts, debridement of all aspects of the joint, irrigation with solutions such as hydrogen peroxide and Betadine Ò solutions, and pulsatile lavage [15,18,20].…”