The Effectiveness of Debridement, Antibiotics and Irrigation for Periprosthetic Joint Infections after Primary Hip and Knee Arthroplasty. A 15 Years Retrospective Study in Two Community Hospitals in the Netherlands.

W Van Der Weegen,Lma De Vries,Hpw Das,W C Neve,B U Ridwan,J Steens

doi:10.7150/jbji.14075

W Van Der Weegen, Lma De Vries + Show 4 more

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https://doi.org/10.7150/jbji.14075

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Abstract

The aim of our study was to evaluate the effectiveness of debridement, antibiotics, irrigation and retention (DAIR) in patients who developed a periprosthetic joint infection (PJI) after primary hip or knee arthroplasty in two community hospitals in the Netherlands. We retrospectively collected data in two hospitals in the Netherlands on all episodes of PJI after primary hip (THA) and knee arthroplasty (TKA) from 1998-2012. In 109 of 8234 THA (1.32%) and 65 of 5752 TKA (1.13%) a PJI developed. DAIR was used as treatment in 84 patients after THA (77.1%) and 56 patients after TKA (86.2%). 34 Patients only received antibiotics or were immediately revised. After 1 year follow-up, prosthesis retention was achieved in 81 THA patients (74.3%) and 48 TKA patients (73.8%). Acute infections showed a better survival compared to late infections (84.0% vs 46.6% respectively; p<0.01). Furthermore, a young age was associated with an increased revision risk (p<0.01). In conclusion, debridement, antibiotics and irrigation in acute PJI may lead to retention of the prosthesis in a majority of cases. Large patient cohort studies can provide data on PJI outcome, complementing National Registries which have limited detail.

Highlights

Periprosthetic joint infections (PJI) have major consequences for patients with a hip or knee prosthesis
The infections were defined as two positive periprosthetic cultures with phenotypically identical organisms, or a sinus tract communicating with the joint, or having three of the following minor criteria: elevated serum C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), elevated synovial fluid white blood cell (WBC) count or ++change on leukocyte esterase test strip, elevated synovial fluid polymorphonuclear neutrophil percentage (PMN%), positive histological analysis of periprosthetic tissue, a single positive culture.[7]
In total hip arthroplasty (THA), 87 infections occurred within 3 months after surgery (79.8%) and in total knee arthroplasty (TKA), 44 infections arose within 3 months after surgery (67.7%)

Summary

Introduction

Periprosthetic joint infections (PJI) have major consequences for patients with a hip or knee prosthesis. An important goal in joint arthroplasty surgery is to prevent PJI and thereby prevent potential revision surgery. To reach this goal, evidence-based protocols on prevention and treatment are necessary, but due to low PJI incidence large patient cohort studies are needed to evaluate these prevention and treatment strategies. Data on the PJI incidence, treatment and survival of primary hip and knee prosthesis from large cohorts might be used to answer these questions. The aim of our study was to evaluate the effectiveness of debridement, antibiotics, irrigation and retention (DAIR) in patients who developed PJI after primary hip or knee arthroplasty in two community hospitals in the Netherlands

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