Abstract
BackgroundDebridement, antibiotics, and implant retention (DAIR) is the recommended treatment for acute hematogenous periprosthetic joint infection (PJI) after total knee arthroplasty (TKA). However, DAIR is associated with a high percentage of unsuccessful outcomes. Since 2007, direct intra-articular antibiotic infusion, which can provide a high concentration of intra-articular antibiotic, has been used in combination with DAIR to improve treatment outcomes among patients in our institution. This study aimed to assess the outcomes of DAIR combined with direct intra-articular antibiotic infusion in patients who presented with acute hematogenous PJI after TKA.MethodsWe reviewed the data of all patients diagnosed with acute hematogenous PJI after primary TKA (from 2008 to 2015) who received DAIR combined with direct intra-articular antibiotic infusion.ResultsIn total, 15 knees in 12 patients were semi-urgently treated with this method. The mean follow-up time was 93.3 (minimum: 56) months, and the longest follow-up time was 11 years. Two patients (n = 3 knees) had a well-functioning, non-infected prosthesis 6 and 10 years after the procedure. Two patients (n = 2 knees) had re-infection 2 and 5 years after surgery, and they required two-stage revision. None of the patients were lost to follow-up. Finally, 13 (86.6%) of 15 infected knees were successfully treated with this method.ConclusionsDAIR combined with direct intra-articular antibiotic infusion is an effective treatment for acute hematogenous PJI after TKA.
Highlights
Prosthetic joint infection (PJI) is a serious complication that occurs after primary total knee arthroplasty (TKA), with incidence rates ranging from 0.5 to 2%
Whiteside et al [8]. showed that the success rate of onestage revision combined with 6-week intra-articular antibiotic infusion for the management of chronic infection after TKA, even methicillin-resistant Staphylococcus aureus infection, was 94%
Our inclusion criteria included all patients with primary TKA who had acute hematogenous infection according to the Tsukayama classification [3] and who received DAIR combined with direct intra-articular antibiotic infusion
Summary
Prosthetic joint infection (PJI) is a serious complication that occurs after primary total knee arthroplasty (TKA), with incidence rates ranging from 0.5 to 2% It is a major cause of revision surgery after TKA, with an Chaiyakit et al BMC Musculoskeletal Disorders (2021) 22:557 in the previous well-functioning knee prosthesis [3]. Since 2007, direct intra-articular antibiotic infusion, which can provide a high concentration of intra-articular antibiotic, has been used in combination with DAIR to improve treatment outcomes among patients in our institution.
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