Prosthesis retention, serial debridement, and antibiotic bead use for the treatment of infection following total joint arthroplasty.
The clinical outcomes of a consecutive series of deep total joint infections treated with a prosthesis retaining protocol were reviewed. Each patient underwent surgical treatment consisting of serial irrigation and debridements, polyethylene exchange when applicable, interval placement and exchange of intra-articular tobramycin/vancomycin-impregnated polymethylmethacrylate beads and 6 weeks of intravenous antibiotics. The primary outcome measures were clinical, radiographic, or laboratory evidence of recurrent prosthetic infection or revision total joint arthroplasty for any reason. At a mean follow-up of 37 months (range, 23-41 months), all infections were eradicated while retaining prosthetic components. No further operative intervention was required for any patient. This treatment protocol can be successful in appropriately selected patients, presenting with early postoperative or acute hematogenous deep total joint infections.
Tintle
Scott M
SM
Department of Orthopedic Surgery, National Naval Medical Center, 8901 Wisconsin Ave, Bethesda, MD 20809, USA.
Forsberg
Jonathan A
JA
Potter
Benjamin K
BK
Islinger
Richard B
RB
Andersen
Romney C
RC
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019643:Arthroplasty, Replacement / Q000009:adverse effects*; D003646:Debridement; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies; D007507:Therapeutic Irrigation; D014031:Tobramycin / Q000008:administration & dosage*; D014640:Vancomycin / Q000008:administration & dosage*
D000900:Anti-Bacterial Agents; D014640:Vancomycin; D014031:Tobramycin