Failure of Irrigation and Débridement for Early Postoperative Periprosthetic Infection

Abstract

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.

Are Cementless Stems More Durable Than Cemented Stems in Two-stage Revisions of Infected Total Knee Arthroplasties?

“…Eliminating periprosthetic infection is dependent on defining the offending organism, the condition of the soft tissue envelope, the ability to perform a thorough débri-dement, and obtaining stable fixation during the second stage of the procedure [9,33,34]. Intramedullary stem use enhances fixation in revision TKA; because of this, most revision knee systems offer cemented and cementless stem extensions to enhance stability of the revision construct.…”

Revision Total Knee Arthroplasty in the Young Patient: Is There Trouble on the Horizon?

“…Infection as the reason for the initial revision surgery was a significant predictor of poor implant survival in both groups, supporting the fact that current methods to treat and eradicate periprosthetic joint infection are inadequate and contribute to substantial morbidity years after an infection diagnosis. While it is out of the scope of this study to compare infection treatment techniques, including irrigation and debridement, one-stage exchange arthroplasty, and two-stage exchange arthroplasty, several reports in the literature suggest that two-stage exchange may be favored in place of simple singlestage procedures for infection [36][37][38] . No other reason for revision significantly impacted cumulative survival after knee revision.…”

Perspectives on the prevention and treatment of infection for orthopedic tissue engineering applications

“…Surgical irrigation and debridement can also be attempted. Pre-clinical animal studies show that early irrigation and debridement, especially in concert with antibiotics, may prevent infection, but clinical studies show that the failure rate of this approach is high if the site is already infected [13][14][15][16]. If the infection is persistent, removal or replacement of the implant becomes necessary.…”