|Beitragstitel||Results of arthroscopic debridement for early post-operative and acute hematogenous periprosthetic knee infections compared to open surgery|
Periprosthetic joint infection is a serious orthopaedic complication. Today we know different types of treatment, direct-exchange arthroplasty and two-stage resection arthroplasty with re-implantation, treatment with debridement and implant retention (DAIR) with component retention. DAIR can be performed open or arthroscopically. Aim of our study was to assess treatment efficacy of arthroscopic versus open DAIR for periprosthetic knee infection. Secondary, we assessed the relationship between disease and patient factors and the need for re-operation due to recurrent infection.
Materials and Methods
In this retrospective study which included patients with a periprosthetic knee infection who were treated with either arthroscopic or open ID between 01/2005 and 05/2015 at the university hospital of Basel. During the study period no specialised multidisciplinary team (MDT) for the treatment of PJI existed, thus the decision was at the discretion of the surgeon on call. Inclusion criteria were (1) McPherson type I infection or McPherson type II infections, (2) patients having a primary total knee arthroplasty, and (3) at least two years’ follow-up after arthroscopic or open DAIR.
A total of 47 patients (48 knees) were included (42 TKA and 6 rTKA). Fourteen patients (14 knees; 29%) were treated with arthroscopic DAIR. Of these, 7 patients (50%) were successfully treated after initial surgery. The remaining 7 patients (50%) returned to the operating room because of persistent/uncontrolled infection. Two had another arthroscopic DAIR while 5 were converted to open DAIR. Thirty-three patients (34 knees; 71%) had an open DAIR. Of these, 24 patients (24 knees; 71%) were successfully treated after initial surgery. Due to persistent PJI, the remaining 9 patients (10 knees) needed a second DAIR during the same hospital stay. Patients undergoing arthroscopic DAIR were 2.4 times more likely to need re-operation as patients undergoing open DAIR for periprosthetic knee infection (OR 2.4; 95% CI (0.67- 8.64; p= 0,181).
The success rate of our open DAIR procedures are inferior to data published in the literature but still are significantly better than the results from the arthroscopic DAIR cohort. With the implementation of a MDT we hope to improve the quality of our open DAIR procedures. Furthermore, the authors would not recommend to perform arthroscopic DAIR as a routine procedure.