title: Arthroscopic debridement for acutely infected prosthetic knee: any role for infection control and prosthesis salvage?
abstract: OBJECTIVE
  The purpose of this study was to assess the success rate of arthroscopic debridement guided by C-reactive protein (CRP) levels for acutely infected total knee prostheses.
  
  
  METHODS
  From January 2002 to December 2009, 16 consecutive eligible patients met the following inclusion criteria: duration of symptoms less than 72 hours, previously well-functioning prostheses, and no radiographic signs of loosening. Each patient underwent arthroscopy with thorough debridement and synovectomy and copious irrigation. In addition to the standard anterior portals, a posterior portal was used, and a drain was placed through this portal. The need for subsequent open debridement was determined by the postarthroscopy trends of CRP levels. Treatment success was defined as continuing freedom from infection based on clinical and laboratory results, salvage of the prosthesis, and no evidence of infection for at least 2 years.
  
  
  RESULTS
  Arthroscopic debridement eradicated the infection in 10 (62.5%) of the 16 cases. The other 6 knees (37.5%) underwent subsequent open debridement with polyethylene insert exchange, which resulted in successful infection control with prosthetic salvage.
  
  
  CONCLUSIONS
  Patients who had undergone total knee arthroplasty (TKA) and had acute joint infection for less than 72 hours with no evidence of a loosening prosthesis were treated by arthroscopic debridement guided by the CRP level and had a 62.5% success rate with arthroscopic treatment alone but a 100% success rate when initial failures were treated with open debridement and polyethylene exchange.
  
  
  METHODS
  Level IV, case series.
authors.affiliation: Department of Orthopedic Surgery, Ajou University School of Medicine, Suwon, South Korea.
authors.forename: Jun Young
authors.initials: JY
authors.lastname: Chung
authors.affiliation: Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. Electronic address: hacw@skku.edu.
authors.forename: Chul-Won
authors.initials: CW
authors.lastname: Ha
authors.affiliation: Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Yong-Beom
authors.initials: YB
authors.lastname: Park
authors.affiliation: Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Young-Joon
authors.initials: YJ
authors.lastname: Song
authors.affiliation: Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Kun-Sik
authors.initials: KS
authors.lastname: Yu
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D001182:Arthroscopy / Q000379:methods*; D015415:Biomarkers / Q000378:metabolism; D002097:C-Reactive Protein / Q000378:metabolism; D003646:Debridement / Q000379:methods*; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007720:Knee Prosthesis / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000209:etiology / Q000378:metabolism / Q000601:surgery*; D016879:Salvage Therapy; D000074402:Synovectomy; D007507:Therapeutic Irrigation; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein