According to a new study, two weeks may be the magic window for avoiding periprosthetic joint infection (PJI).
New Study: Early Irrigation Debridement vs. Joint Infection
1 min read Premium comments
Secondary
The research, “Irrigation and Debridement for Early Periprosthetic Knee Infection: Is It Effective?” appears in the January 9, 2018 edition of The Journal of Arthroplasty. The authors found that patients with early PJI who underwent irrigation and debridement (I&D) and liner exchange within two weeks of total knee arthroplasty (TKA) fared better than those who underwent the same treatment after the two week mark.
Ran Schwarzkopf, M.D. is with the Department of Orthopedic Surgery at New York University Langone Orthopedic Hospital. A co-author on the study, Dr. Schwarzkopf told OTW, “As infections continue to be the major reason for revision surgery after TKA as well as the cost to the patient emotionally and to the health system.”
The authors wrote, “From 2009-2017, retrospective review was performed of 55 knee PJI cases at our institution. All patients underwent polyethylene liner exchange and I&D for PJI…Average follow-up time after index-TKA was 2.5 years.”
“Among patients with I&D within 2-weeks of index-TXA, 14 patients (82%) were successfully treated while 3 (18%) had infection recurrence.”
“These outcomes were significantly improved compared to patients with I&D after 2-weeks: 19 (50%) successes and 19 (50%) failures. Staphylococcal species were the most frequent pathogen in patients treated before and after 2-weeks of index-TKA (39% and 50%, respectively)…”
Dr. Schwarzkopf commented to OTW, “As soon as there is a diagnosis of infection the patient should be considered for surgery as the results are better the sooner we operate and do the DAIR (debridement, exchange of modular parts, antibiotic treatment, and implant retention) procedure.”
React:
Discussion
This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
Join the conversation
Orthopedic professionals are discussing this. Sign in and upgrade to read every comment and add your voice.