Knee Surg Relat Res.  2017 Sep;29(3):172-179. 10.5792/ksrr.16.040.

Efficacy of Open Debridement and Polyethylene Exchange in Strictly Selected Patients with Infection after Total Knee Arthroplasty

• Son WS
• Shon OJ
• Lee DC
• Park SJ
• Yang HS

• KMID: 2389252
• DOI: http://doi.org/10.5792/ksrr.16.040

Abstract

PURPOSE
To assess the efficacy of open debridement and polyethylene exchange (ODPE) combined with proper antibiotic therapy in strictly selected patients with infection after total knee arthroplasty (TKA) and analyze factors associated with treatment failure.
MATERIALS AND METHODS
From January 2010 to January 2014, 25 cases that underwent ODPE under the diagnosis of infection within four weeks after TKA or acute hematogenous infection within five days of symptom onset were reviewed in this study.
RESULTS
Treatment was successful in 22 out of 25 cases (88.0%). Factors associated with failure were accompanying infection (periprosthetic infection in the ipsilateral foot, cervical parotid abscess, and masticator space abscess) and diagnosis of rheumatoid arthritis (RA) before TKA. Resistant bacteria did not entail a risk. On clinical results, the mean postoperative Lysholm score and Korean Knee score were 81.4 and 79.4, respectively, the knee range of motion was 115.4°±12.9°, and duration of hospitalization was 32.3±8.4 days. On radiographic results, 3.47±1.56 mm joint line elevation and a valgus change of 0.61°±2.35° in knee alignment were observed.
CONCLUSIONS
ODPE combined with appropriate antibiotics therapy could be a useful treatment method for infection after TKA if the procedure is performed within a symptom duration of five days or less in the absence of accompanying infection in patients whose indication for TKA was not RA.

Keyword

Knee; Arthroplasty; Infection; Debridement

MeSH Terms

Abscess
Anti-Bacterial Agents
Arthritis, Rheumatoid
Arthroplasty
Arthroplasty, Replacement, Knee*
Bacteria
Debridement*
Diagnosis
Foot
Hospitalization
Humans
Joints
Knee
Methods
Polyethylene*
Range of Motion, Articular
Treatment Failure
Anti-Bacterial Agents
Polyethylene