title: Irrigation and Debridement Before a 2-Stage Revision Total Knee Arthroplasty Does Not Increase Risk of Failure.
abstract: BACKGROUND
  Studies have suggested that the success of 2-stage revision total knee arthroplasty (rTKA) may be compromised by a prior failed irrigation and debridement (I&D). The purpose of this study was to use 2 large state inpatient databases to compare the 2-stage rTKA failure rates for those patients with and without a prior I&D.
  
  
  METHODS
  This retrospective, longitudinal study used inpatient discharge data from the State Inpatient Database of 2 states (California and New York) from 2005 to 2011. A combination of International Classification of Diseases, Ninth Revision, diagnosis and procedure codes was used to identify rTKA patients and compare failure rates for rTKA patients with and without prior I&D. The primary outcome was failure of the staged revision, which was defined as subsequent surgery due to infection within 4 years of the 2-stage rTKA.
  
  
  RESULTS
  Of the 750 patients who underwent 2-stage rTKA, 57 had undergone a prior I&D. In all, 126 patients failed rTKA. After 4 years, the estimated failure rate was 8.7% (95% confidence interval [CI], 1.9%-16.9%) in the group with prior I&D and 17.5% (95% CI, 14.7%-20.4%) in the group without prior I&D. After adjusting for sex, race, insurance, median household income, and comorbidities, the hazard ratio for the group with a failed I&D was 0.49 (P = .122; 95% CI, 0.20-1.20), which indicated a lower risk of failure compared to the group without prior I&D.
  
  
  CONCLUSIONS
  These findings indicate that the failure rate of 2-stage rTKA is not increased by prior failed I&D.
authors.affiliation: Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Olubusola
authors.initials: O
authors.lastname: Brimmo
authors.affiliation: Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Deepak
authors.initials: D
authors.lastname: Ramanathan
authors.affiliation: Department of Epidemiology & Biostatistics, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Nicholas K
authors.initials: NK
authors.lastname: Schiltz
authors.affiliation: Department of Epidemiology & Biostatistics, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Aiswarya Lekshmi Pillai Chandran
authors.initials: AL
authors.lastname: Pillai
authors.affiliation: Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Alison K
authors.initials: AK
authors.lastname: Klika
authors.affiliation: Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Wael K
authors.initials: WK
authors.lastname: Barsoum
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000706:statistics & numerical data*; D002140:California; D015897:Comorbidity; D003646:Debridement / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007720:Knee Prosthesis / Q000009:adverse effects; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009518:New York; D010351:Patient Discharge; D016016:Proportional Hazards Models; D016459:Prosthesis-Related Infections / Q000601:surgery*; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D007507:Therapeutic Irrigation / Q000009:adverse effects; D017211:Treatment Failure
keywords: State Inpatient Database; failure rate; irrigation and debridement; prosthetic joint infection; revision total knee arthroplasty