title: Functional outcomes of acutely infected knee arthroplasty: a comparison of different surgical treatment options.
abstract: BACKGROUND
  An infected total knee arthroplasty (TKA) can be treated with irrigation and débridement with polyethylene exchange (IDPE) or a 2-staged revision (2SR). Although research has examined infection eradication rates of both treatments, patient outcomes have not been reported. We examined patient-reported outcomes following treatment compared with matched, noninfected controls.
  
  
  METHODS
  We retrospectively identified patients with infected TKAs who had undergone the index procedure between May 1991 and November 2011. Patient-reported outcomes included the 12-item Short Form Health Survey, Western Ontario and McMaster Universities Arthritis Index, and Knee Society Scores as well as range of motion. Patients with noninfected primary TKAs matched by age and age-adjusted Charlson Comorbidity Index score were used as controls. Intention-to-treat groups of 2SR and IDPE were used, with the IDPE group subdivided into successful and unsuccessful groups.
  
  
  RESULTS
  We included 145 patients with infected TKAs with mean follow-up of 64.2 months and 145 controls with a mean follow-up of 35.4 months in our analysis. Outcomes of the controls and the successful IDPE groups were equivalent. The 2SR cohort had lower scores in all categories than controls. There was a 39% success rate in eradicating infection with IDPE. Patients in whom IDPE failed had lower scores in all categories than controls. There was no difference between the failed IDPE group and the 2SR group.
  
  
  CONCLUSIONS
  Controversy regarding treatment options for acutely infected TKA has been focused on infection eradication. However, functional outcomes following treatment need to be taken into consideration. Patients whose infections were successfully treated with IDPE had equivalent outcomes to controls.
authors.affiliation: From the Department of Orthopaedic Surgery, Western University (Dzaja, Howard, Lanting); and the Department of Orthopaedic Surgery, London Health Sciences Centre (Howard, Somerville, Lanting), London, Ont.
authors.forename: Ivan
authors.initials: I
authors.lastname: Dzaja
authors.affiliation: From the Department of Orthopaedic Surgery, Western University (Dzaja, Howard, Lanting); and the Department of Orthopaedic Surgery, London Health Sciences Centre (Howard, Somerville, Lanting), London, Ont.
authors.forename: James
authors.initials: J
authors.lastname: Howard
authors.affiliation: From the Department of Orthopaedic Surgery, Western University (Dzaja, Howard, Lanting); and the Department of Orthopaedic Surgery, London Health Sciences Centre (Howard, Somerville, Lanting), London, Ont.
authors.forename: Lyndsay
authors.initials: L
authors.lastname: Somerville
authors.affiliation: From the Department of Orthopaedic Surgery, Western University (Dzaja, Howard, Lanting); and the Department of Orthopaedic Surgery, London Health Sciences Centre (Howard, Somerville, Lanting), London, Ont.
authors.forename: Brent
authors.initials: B
authors.lastname: Lanting
mesh_terms: D000208:Acute Disease; D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D003646:Debridement / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007719:Knee Joint / Q000601:surgery*; D008297:Male; D016459:Prosthesis-Related Infections / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies