title: Debridement with prosthesis retention and antibiotherapy vs. two-stage revision for periprosthetic knee infection within 3 months after arthroplasty: a case-control study.
abstract: Sixty-four patients with periprosthetic infection within 3 months of index arthroplasty, of whom 39 underwent debridement with prosthesis retention and antibiotherapy (DPRA), and 25 underwent two-stage revision (2SR), were compared regarding control of infection and functional outcomes by use of Knee Society scores. Failure was defined as the need for subsequent surgery to control infection. The failure rate after DPRA was 61.5%, and that after 2SR was 12.0% (p 0.001). The failure risk was not significantly associated with the duration of symptoms (≤4 weeks). The only predictor of failure was isolation of Staphylococcus aureus or Staphylococcus epidermidis. Treatment with 2SR required fewer surgical operations, a shorter duration of hospitalization, and a shorter duration of treatment. All patients who required a second debridement ultimately underwent prosthesis removal. The functional outcome was significantly better for 2SR at the last follow-up.
authors.affiliation: Orthopaedic Surgery, Elda University Hospital, Elda, Alicante, Spain. Electronic address: lizaur1@telefonica.net.
authors.forename: A
authors.initials: A
authors.lastname: Lizaur-Utrilla
authors.affiliation: Orthopaedic Surgery, Elda University Hospital, Elda, Alicante, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Gonzalez-Parreño
authors.affiliation: Unit of Clinical Investigation, Elda University Hospital, Elda, Alicante, Spain.
authors.forename: V
authors.initials: V
authors.lastname: Gil-Guillen
authors.affiliation: Orthopaedic Surgery, Miguel Hernandez University, Elche, Alicante, Spain.
authors.forename: F A
authors.initials: FA
authors.lastname: Lopez-Prats
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D016022:Case-Control Studies; D003646:Debridement; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D060489:Prosthesis Retention; D016459:Prosthesis-Related Infections / Q000188:drug therapy* / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D017211:Treatment Failure
chemical_list: D000900:Anti-Bacterial Agents
keywords: Debridement; Staphylococcus; periprosthetic infection; total knee arthroplasty; two-stage revision