Can this prosthesis be saved?: implant salvage attempts in infected primary TKA.
BACKGROUND
Open débridement with polyethylene liner exchange (ODPE) remains a relatively low morbidity option in acute infection of total knee arthroplasty (TKA), but concerns regarding control of infection exist. We sought to identify factors that would predict control of infection after ODPE.


METHODS
We identified 44 patients (44 knees) with culture-positive periprosthetic infection who underwent ODPE. Failure was defined as any reoperation performed for control of infection or the need for lifetime antibiotic suppression. Patients had been followed prospectively for a minimum of 1 year (mean, 5 years; range, 1-9 years).


RESULTS
Twenty-five of the 44 patients (57%) failed ODPE. Of these 25 patients, two had one additional procedure, 21 had more than one additional procedure, and two required lifetime antibiotic suppression. Failure rates tended to differ based on primary organism: 71% of Staphylococcus aureus periprosthetic infection failed versus 29% of Staphylococcus epidermidis, although with the limited numbers theses differences were not significant. Age, gender, or measures of comorbidity did not influence the risk of failure. There was no difference in failure rate (58% versus 50%) when the ODPE was performed greater than 4 weeks after index TKA. After a failed ODPE, 19 of the 25 failures went on to an attempted two-stage revision procedure. In only 11 of these 19 cases was the two-stage revision ultimately successful.


CONCLUSIONS
Eradication of infection with ODPE in acute TKA infections is unpredictable; certain factors trend toward increased success but no firm algorithm can be offered. The success of two-stage revision for infection may be diminished after a failed ODPE.


METHODS
Level III, retrospective comparative study. See Guidelines for Authors for a complete description of levels of evidence.
Gardner
Jeremy
J
Department of Orthopaedic Surgery, University of Minnesota Medical School, Minneapolis, MN, USA.
Gioe
Terence J
TJ
Tatman
Penny
P
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000295:instrumentation; D016009:Chi-Square Distribution; D003646:Debridement; D020878:Device Removal; D005260:Female; D006801:Humans; D017053:Infection Control / Q000379:methods; D053208:Kaplan-Meier Estimate; D007720:Knee Prosthesis; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D020959:Polyethylene; D011474:Prosthesis Design; D016459:Prosthesis-Related Infections / Q000382:microbiology / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D020959:Polyethylene