title: Is There Still a Role for Irrigation and Debridement With Liner Exchange in Acute Periprosthetic Total Knee Infection?
abstract: Periprosthetic joint infection (PJI) is an important cause of failure in total knee arthroplasty. Irrigation and debridement including liner exchange (I&D/L) success rates have varied for acute PJI. The purpose of this study is to present results of a specific protocol for I&D/L with retention of total knee arthroplasty components.
  
  
  
  Sixty-seven consecutive I&D/L patients were retrospectively evaluated. Inclusion criteria for I&D/L were as follows: fewer than 3 weeks of symptoms, no immunologic compromise, intact soft tissue sleeve, and well-fixed components. I&D/L consisted of extensive synovectomy; irrigation with 3 L each of betadine, Dakin's, bacitracin, and normal saline solutions; and exchange of the polyethylene component. Postoperatively, all patients were treated with intravenous antibiotics. Infection was considered eradicated if the wound healed without persistent drainage, there was no residual pain or evidence of infection.
  
  
  
  Forty-six patients (68.66%) had successful infection eradication regardless of bacterial strain. Those with methicillin-resistant Staphylococcus aureus (MRSA) had an 80% failure rate and those with Pseudomonas aeruginosa had a 66.67% failure rate. The success rate for bacteria other than MRSA and Pseudomonas was 85.25%.
  
  
  
  Our protocol for I&D/L was successful in the majority of patients who met strict criteria. We recommend that PJI patients with MRSA or P aeruginosa not undergo I&D/L and be treated with 2-stage revision. For nearly all other patients, our protocol avoids the cost and patient morbidity of a 2-stage revision.
authors.affiliation: Rothman Institute of Orthopaedics at Thomas Jefferson University, Egg Harbor Township, New Jersey.
authors.forename: Andrés F
authors.initials: AF
authors.lastname: Duque
authors.affiliation: Rothman Institute of Orthopaedics at Thomas Jefferson University, Egg Harbor Township, New Jersey.
authors.forename: Zachary D
authors.initials: ZD
authors.lastname: Post
authors.affiliation: Rothman Institute of Orthopaedics at Thomas Jefferson University, Egg Harbor Township, New Jersey.
authors.forename: Rex W
authors.initials: RW
authors.lastname: Lutz
authors.affiliation: Rothman Institute of Orthopaedics at Thomas Jefferson University, Egg Harbor Township, New Jersey.
authors.forename: Fabio R
authors.initials: FR
authors.lastname: Orozco
authors.affiliation: Orthopedic Department, Rowan University School of Osteopathic Medicine, Stratford, New Jersey.
authors.forename: Sergio H
authors.initials: SH
authors.lastname: Pulido
authors.affiliation: Rothman Institute of Orthopaedics at Thomas Jefferson University, Egg Harbor Township, New Jersey.
authors.forename: Alvin C
authors.initials: AC
authors.lastname: Ong
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D001170:Arthritis, Infectious / Q000209:etiology / Q000601:surgery*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D003646:Debridement / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000601:surgery; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification; D008875:Middle Aged; D020959:Polyethylene; D011184:Postoperative Period; D016459:Prosthesis-Related Infections / Q000382:microbiology / Q000601:surgery*; D012189:Retrospective Studies; D000074402:Synovectomy; D007507:Therapeutic Irrigation / Q000379:methods* / Q000706:statistics & numerical data; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D020959:Polyethylene
keywords: acute periprosthetic joint infection; debridement; infection; irrigation; total knee arthroplasty