title: 75% success rate after open debridement, exchange of tibial insert, and antibiotics in knee prosthetic joint infections.
abstract: OBJECTIVE
  Prosthetic joint infection (PJI) is a leading cause of early revision after total knee arthroplasty (TKA). Open debridement with exchange of tibial insert allows treatment of infection with retention of fixed components. We investigated the success rate of this procedure in the treatment of knee PJIs in a nationwide material, and determined whether the results were affected by microbiology, antibiotic treatment, or timing of debridement.
  
  
  METHODS
  145 primary TKAs revised for the first time, due to infection, with debridement and exchange of the tibial insert were identified in the Swedish Knee Arthroplasty Register (SKAR). Staphylococcus aureus was the most common pathogen (37%) followed by coagulase-negative staphylococci (CNS) (23%). Failure was defined as death before the end of antibiotic treatment, revision of major components due to infection, life-long antibiotic treatment, or chronic infection.
  
  
  RESULTS
  The overall healing rate was 75%. The type of infecting pathogen did not statistically significantly affect outcome. Staphylococcal infections treated without a combination of antibiotics including rifampin had a higher failure rate than those treated with rifampin (RR = 4, 95% CI: 2-10). In the 16 cases with more than 3 weeks of symptoms before treatment, the healing rate was 62%, as compared to 77% in the other cases (p = 0.2). The few patients with a revision model of prosthesis at primary operation had a high failure rate (5 of 8).
  
  
  CONCLUSIONS
  Good results can be achieved by open debridement with exchange of tibial insert. It is important to use an antibiotic combination including rifampin in staphylococcal infections.
authors.affiliation: Division of Infection Medicine, Department of Clinical Sciences, Lund University , Lund.
authors.forename: Anna
authors.initials: A
authors.lastname: Holmberg
authors.forename: Valdís Gudrún
authors.initials: VG
authors.lastname: Thórhallsdóttir
authors.forename: Otto
authors.initials: O
authors.lastname: Robertsson
authors.forename: Annette
authors.initials: A
authors.lastname: W-Dahl
authors.forename: Anna
authors.initials: A
authors.lastname: Stefánsdóttir
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D003646:Debridement / Q000379:methods*; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007720:Knee Prosthesis / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000628:therapy*; D012042:Registries; D012086:Reoperation; D012189:Retrospective Studies; D012293:Rifampin / Q000627:therapeutic use*; D013211:Staphylococcus aureus / Q000302:isolation & purification; D013548:Sweden; D013977:Tibia / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing
chemical_list: D000900:Anti-Bacterial Agents; D012293:Rifampin