- debridement w/o component removal:
-
IV antibiotic therapy has limited success in treatment of infected TKR;
- in the study by Segawa et al (JBJS Vol 81-A 1999), 5 out of 10 deep infections which were diagnosed in the acute postoperative period were successfully
managed with wound debridement, polyethyene exchange, application of temporary antibiotic beads, and IV antibiotics;
-
indications:
- early acute hematogenous infection occurring around previously secure & well functioning prosthesis;
- in the study by Segawa MD et al. 1999, 5 of 7 hematogenous infection were treated successfully with debridement, IV antibiotics, and prosthetic retention;
- post operative infection may be successfully treated w/ ATB and debridement, if delay of treatment is less than 3-4 weeks;
- in chronic infections, infectious process often extends to the bone-cement interface, resulting in loosening and resistent infection;
-
relative contra-indications:
- success w/
gm negative infections is dismal and success w/ resistant
staph infections is fair to poor;
-
management: (see
antibiotics)
- debridment can be open or
arthroscopic;
- debridement can be combined with polyethylene exchange and possibly insertion of antibiotic beads;
- administration of intravenous bactericidal antibiotic, selected after susceptibility testing - antibiotics are adminstered for 4-6 weeks;
- consider
postoperative articular antibiotic infusion:
Treatment of infection after total knee arthroplasty by debridement with retention of the components.
Infection After Total Knee Arthroplasty. A Retrospective Study of the Treatment of Eighty-One Infections* H Segawa MD et al. JBJS Oct 1999. Vol 81-A. No 10 page 1434.
Open debridement of acute gram-positive infections after total knee arthroplasty.
Arthroscopic debridement of acute periprosthetic septic arthritis of the knee.
Multiple irrigation, debridement, and retention of components in infected total knee arthroplasty.
Arthroscopic irrigation and debridement of infected total knee arthroplasty: report of two cases.
