Jun Young Chung1, Chul-Won Ha2, Yong-Beom Park3, Young-Joon Song3, Kun-Sik Yu3. 1. Department of Orthopedic Surgery, Ajou University School of Medicine, Suwon, South Korea. 2. Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. Electronic address: hacw@skku.edu. 3. Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Abstract
PURPOSE: The purpose of this study was to assess the success rate of arthroscopic debridement guided by C-reactive protein (CRP) levels for acutely infected total knee prostheses. METHODS: From January 2002 to December 2009, 16 consecutive eligible patients met the following inclusion criteria: duration of symptoms less than 72 hours, previously well-functioning prostheses, and no radiographic signs of loosening. Each patient underwent arthroscopy with thorough debridement and synovectomy and copious irrigation. In addition to the standard anterior portals, a posterior portal was used, and a drain was placed through this portal. The need for subsequent open debridement was determined by the postarthroscopy trends of CRP levels. Treatment success was defined as continuing freedom from infection based on clinical and laboratory results, salvage of the prosthesis, and no evidence of infection for at least 2 years. RESULTS: Arthroscopic debridement eradicated the infection in 10 (62.5%) of the 16 cases. The other 6 knees (37.5%) underwent subsequent open debridement with polyethylene insert exchange, which resulted in successful infection control with prosthetic salvage. CONCLUSIONS: Patients who had undergone total knee arthroplasty (TKA) and had acute joint infection for less than 72 hours with no evidence of a loosening prosthesis were treated by arthroscopic debridement guided by the CRP level and had a 62.5% success rate with arthroscopic treatment alone but a 100% success rate when initial failures were treated with open debridement and polyethylene exchange. LEVEL OF EVIDENCE: Level IV, case series.
PURPOSE: The purpose of this study was to assess the success rate of arthroscopic debridement guided by C-reactive protein (CRP) levels for acutely infected total knee prostheses. METHODS: From January 2002 to December 2009, 16 consecutive eligible patients met the following inclusion criteria: duration of symptoms less than 72 hours, previously well-functioning prostheses, and no radiographic signs of loosening. Each patient underwent arthroscopy with thorough debridement and synovectomy and copious irrigation. In addition to the standard anterior portals, a posterior portal was used, and a drain was placed through this portal. The need for subsequent open debridement was determined by the postarthroscopy trends of CRP levels. Treatment success was defined as continuing freedom from infection based on clinical and laboratory results, salvage of the prosthesis, and no evidence of infection for at least 2 years. RESULTS: Arthroscopic debridement eradicated the infection in 10 (62.5%) of the 16 cases. The other 6 knees (37.5%) underwent subsequent open debridement with polyethylene insert exchange, which resulted in successful infection control with prosthetic salvage. CONCLUSIONS:Patients who had undergone total knee arthroplasty (TKA) and had acute joint infection for less than 72 hours with no evidence of a loosening prosthesis were treated by arthroscopic debridement guided by the CRP level and had a 62.5% success rate with arthroscopic treatment alone but a 100% success rate when initial failures were treated with open debridement and polyethylene exchange. LEVEL OF EVIDENCE: Level IV, case series.
Authors: S Heaven; Darren de Sa; N Simunovic; D S Williams; D Naudie; O R Ayeni Journal: Knee Surg Sports Traumatol Arthrosc Date: 2014-11-20 Impact factor: 4.342
Authors: Moneer M Abouljoud; David Backstein; Andrew Battenberg; Matthew Dietz; Alejo Erice; Andrew A Freiberg; Jeffrey Granger; Adam Katchky; Anton Khlopas; Tae-Kyun Kim; Per Kjaersgaard-Andersen; Kyung-Hoi Koo; Yona Kosashvili; Percia Lazarovski; Jennifer Leighton; Adolph Lombardi; Konstantinos Malizos; Jorge Manrique; Michael A Mont; Marianthe Papanagiotoy; Rafael J Sierra; Nipun Sodhi; John Stammers; Maik Stiehler; Timothy L Tan; Katsufumi Uchiyama; Derek Ward; Anna Ziogkou Journal: J Arthroplasty Date: 2018-10-19 Impact factor: 4.757