Debridement and Polyethylene Exchange in Prosthetic Joint Infection following Total Knee Arthroplasty

Presenting Author - JIGAR B CHHAPAN
This study aims to report our experience of managing acute periprosthetic joint infection (PJI) following total knee arthroplasty (TKA) with surgical debridement, polyethylene insert exchange and prostheses retention. A review of patients in our hospital joint replacement register from 2011 to 2016 was performed. In this study, 57 patients of PJI following TKAs who were treated with debridement and polyethylene exchange with retention of prosthesis were included. Infection was identified after mean follow-up of 7.7±9.8 months of primary TKA. 35% infections were early (within 3 months), 51% were delayed (3-12 months), 14% were haematogenous infection (more than 1 year). Preoperative in all the patients, there were signs of infection without implant loosening. After a mean follow-up of 3.6 years (minimum 1 year), 33 were successfully treated, while 24 failed. Patients who were failed either required reoperations or prolong antibiotic suppression. The success rate of debridement with poly exchange was 57.9%. Statistical analyses showed no significant differences (p>0.05) between success and failure groups on patients’ age, time lag between primary TKA and debridement, preoperative C-reactive protein, erythrocyte sedimentation rate, white blood cell count or diabetes level. 45.6% showed no growth of organism on culture examination, staphylococcal infection was present in 38.6% and other organism in 15.6% of patients. Microbiological growth has no significant impact on surgical outcome. We concluded that debridement with prostheses retention has a moderate success rate for acute PJI following TKA. The polyethylene insert should be exchanged during surgery which will give more palatable option for the patient with promising rate of success while being less expensive and successful trial before going for 2 stage revision surgery.