Risk of Reinfection after Irrigation and Debridement of Acute Periprosthetic Joint Infection following TKA

Abstract

The purpose of this study was to determine the risk factors associated with reinfection in patients treated with irrigation and debridement (I&D) with liner exchange for an acute (less than 3 months) prosthetic joint infection following the index primary total knee arthroplasty (TKA). Medicare claims database was queried to identify patients with periprosthetic joint infection within 3 months of their index TKA who underwent I&D with tibial polyethylene liner exchange. Exclusion criteria included age < 65 years and < 1 year of claims prior to TKA. A total of 341 patients met our criteria and were analyzed by age, sex, diabetes, obesity, Charlson comorbidity score, and time between TKA and I&D with liner exchange. Average time to I&D with liner exchange following primary TKA was 38.5 ± 21.3 days and multivariate analysis showed a significantly higher risk of reinfection within 1 year in patients > 85 years old (p < 0.001) and diabetes (p < 0.02). The risk of reinfection was lowest for patients treated with I&D with liner exchange within 14 days after TKA (p = 0.028). The incidence of reinfection was 223% greater if I&D with liner exchange was performed 2 to 4 weeks after primary TKA (p < 0.03), and 277% higher if performed > 6 weeks after index procedure compared with those performed within 2 weeks. Patients older than 85 years, diabetics, or treated with I&D with liner exchange > 14 days following the primary TKA had a significantly higher risk of reinfection within 1 year. Patients should be cautioned on the risk of reinfection prior to proceeding with I&D with liner exchange > 2 weeks following the index procedure.

The Fate of Failed Debridement, Antibiotics, and Implant Retention in Infected Knee Arthroplasties: Nothing to Lose

“…Methicillin-resistant microorganisms [ 7 , 23 ] and comorbidities [ 8 , 9 ] are reported to be associated with failure after DAIR, and these findings are supported by our results. On the other hand, while the time passed since the index arthroplasty is reported to be associated with poorer outcomes [ 9 ], our results do not support this. Instead, time passed since the onset of the symptoms is a risk factor.…”

“…DAIR is reported to be successful in 22.6%-83% of the patients [ 6 ]. The main reasons for failure are highly-virulent organisms, comorbidities like chronic obstructive lung disease and diabetes mellitus, age older than 85, and DAIR performed after more than 30 days of index arthroplasty [ 7 - 9 ].…”

What’s New in Musculoskeletal Infection

“…The timing of DAIR for TKA remains important to the success rate. The best results were found in patients who underwent DAIR within 2 weeks of the index arthroplasty, with a 223% increase in reinfection if these procedures were performed after 2 weeks 57 .…”