Orthopaedic Knowledge Update®: Musculoskeletal Infection 2 Print + Ebook (AAOS - American Academy of Orthopaedic Surgeons)

Section 4: Prosthetic Joint Infections

11. Chung AS, Niesen MC, Graber TJ, et al: Two-stage debride ment with prosthesis retention for acute periprosthetic joint infections. J Arthroplasty 2019;34(6):1207-1213. This retrospective study evaluated the success of infection pre vention at 1 year after a two-stage débridement with implant retention: 83% of patients who underwent total hip arthro plasty and 90% of patients who underwent TKA remained infection free at 1 year. Level of evidence: IV. 12. Ottesen CS, Troelsen A, Sandholdt H, Jacobsen S, Husted H, Gromov K: Acceptable success rate in patients with peripros thetic knee joint infection treated with debridement, antibiotics, and implant retention. J Arthroplasty 2019;34(2):365-368. Fifty-eight patients with acute PJI were reviewed. DAIR was successful in 43 of 48 of patients (90%) who underwent the procedure within 90 days of their index procedure regardless of antibiotic organism. Level of evidence: IV. 13. Urish KL, Bullock AG, Kreger AM, et al: A multicenter study of irrigation and debridement in total knee arthro plasty periprosthetic joint infection: Treatment failure is high. J Arthroplasty 2018;33(4):1154-1159. A multicenter, observational cohort study of 216 patients that underwent irrigation and débridement with implant retention. The authors report a failure rate of 57.4% at 4 years. Level of evidence: III. 14. Deirmengian C, Greenbaum J, Lotke PA, Booth RE Jr, Lonner JH: Limited success with open debridement and reten tion of components in the treatment of acute Staphylococcus aureus infections after total knee arthroplasty. J Arthroplasty 2003;18(7 suppl 1):22-26. 15. Shohat N, Goswami K, Tan TL, Fillingham Y, Parvizi J: Increased failure after irrigation and debridement for acute hematogenous periprosthetic joint infection. J Bone Joint Surg Am 2019;101(8):696-703. This analysis of 199 patients with PJI treated with DAIR demonstrated a failure rate of 56% for those with acute hematogenous infections versus 31% for those with acute postsurgical infections. Level of evidence: I. 16. Nace J, Siddiqi A, Talmo CT, Chen AF: Diagnosis and man agement of fungal periprosthetic joint infections. J Am Acad Orthop Surg 2019;27(18):e804-e818. This review focuses on fungal PJIs. Level of evidence: IV. 17. Tornero E, Morata L, Martínez-Pastor J, et al: KLIC-score for predicting early failure in prosthetic joint infections treated with debridement, implant retention and antibiotics. Clin Microbiol Infect 2015;21(8):786.e9-786.e17. 18. Sherrell JC, Fehring TK, Odum S, et al: The Chitranjan Ranawat Award: Fate of two-stage reimplantation after failed irrigation and débridement for periprosthetic knee infection. Clin Orthop Relat Res 2011;469(1):18-25. 19. Brimmo O, Ramanathan D, Schiltz NK, Pillai AL, Klika AK, Barsoum WK: Irrigation and debridement before a 2-stage revision total knee arthroplasty does not increase risk of failure. J Arthroplasty 2016;31(2):461-464. 20. Nodzo SR, Boyle KK, Nocon AA, Henry MW, Mayman DJ, Westrich GH: The influence of a failed irrigation

and debridement on the outcomes of a subsequent 2-stage revi sion knee arthroplasty. J Arthroplasty 2017;32(8):2508-2512. 21. Rajgopal A, Panda I, Rao A, Dahiya V, Gupta H: Does prior failed debridement compromise the outcome of sub sequent two-stage revision done for periprosthetic joint infection following total knee arthroplasty? J Arthroplasty 2018;33(8):2588-2594. An observational cohort study of 184 knees that underwent a two-stage exchange for PJI. The authors reported that those patients who previously failed an attempt at irrigation and débridement with implant retention had inferior outcomes and higher failure rates after subsequent two-stage exchange. Level of evidence: IV. 22. Kim K, Zhu M, Cavadino A, Munro JT, Young SW: Failed debridement and implant retention does not compromise the success of subsequent staged revision in infected total knee arthroplasty. J Arthroplasty 2019;34(6):1214-1220.e1. This multicenter retrospective review analyzed 291 patients: 228 underwent DAIR and 63 underwent a staged revision. In the DAIR group, 75 patients experienced treatment failure. At a mean follow-up of 6.2 years, the success rates were 72% for the failed DAIR group and 81% in the staged revision group. Multivariate analysis suggested that previously failed DAIR does not significantly compromise success of a staged revision. Level of evidence: I. 23. Kheir MM, Tan TL, Gomez MM, Chen AF, Parvizi J: Patients with failed prior two-stage exchange have poor outcomes after further surgical intervention. J Arthroplasty 2017;32(4):1262-1265. 24. Insall JN, Thompson FM, Brause BD: Two-stage reimplanta tion for the salvage of infected total knee arthroplasty. J Bone Joint Surg Am 1983;65(8):1087-1098. 25. Hipfl C, Winkler T, Janz V, Perka C, Müller M: Management of chronically infected total knee arthroplasty with severe bone loss using static spacers with intramedullary rods. J Arthroplasty 2019;34(7):1462-1469. This study used sonication results to determine if intramed ullary rods caused reinfection when used with a static spacer. Sonication results were positive in 2% of cases and none of those failed. Most reinfections grew different organisms than the initial infection. Level of evidence: IV. 26. Lichstein P, Su S, Hedlund H, et al: Treatment of peripros thetic knee infection with a two-stage protocol using static spacers. Clin Orthop Relat Res 2016;474(1):120-125. 27. Röhner E, Pfitzner T, Preininger B, Zippelius T, Perka C: Temporary arthrodesis using fixator rods in two-stage revision of septic knee prothesis with severe bone and tissue defects. Knee Surg Sports Traumatol Arthrosc 2016;24(1):84-88. 28. Lachiewicz PF, Wellman SS, Peterson JR: Antibiotic cement spacers for infected total knee arthroplasties. J Am Acad Orthop Surg 2020;28(5):180-188. This review focuses on spacers used in two-stage exchanged for PJI. Level of evidence: I.

Section 4: Prosthetic Joint Infections

29. Zielinski MR, Ziemba-Davis M, Warth LC, Keyes BJ, Meneghini RM: Do antibiotic intramedullary dowels assist Copyright © Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited. 2023

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Orthopaedic Knowledge Update ® : Musculoskeletal Infection 2