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Clinical Orthopaedics and Related Research®
Published in: Clinical Orthopaedics and Related Research® 1/2011

01-01-2011 | Symposium: Papers Presented at the Annual Meetings of the Knee Society

The Chitranjan Ranawat Award: Fate of Two-stage Reimplantation After Failed Irrigation and Débridement for Periprosthetic Knee Infection

Authors: J. Christopher Sherrell, MD, Thomas K. Fehring, MD, Susan Odum, MEd, Erik Hansen, MD, Benjamin Zmistowski, BS, Anne Dennos, BS, Niraj Kalore, MD, the Periprosthetic Infection Consortium

Published in: Clinical Orthopaedics and Related Research® | Issue 1/2011

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Abstract

Background

Irrigation and débridement is an attractive low morbidity solution for acute periprosthetic knee infection. However, the failure rate in the literature is high, averaging 68% (range, 61%–82%). Patients who fail subsequently undergo two-stage reimplantation after a prolonged period of illness. This leads to higher surgical risk and further delays in rehabilitation and may contribute to failure of subsequent revision surgery.

Questions/purposes

We determined the rerevision rate due to infection after two-stage reimplantation performed for failed irrigation and débridement of infected TKA.

Methods

We performed a multicenter retrospective review of periprosthetic knee infections treated with a two-stage procedure from 1994 to 2008. Selection criteria for the study included initial treatment with irrigation and débridement and subsequent two-stage revision surgery. Failure of two-stage revision was defined as the need for any additional surgery due to infection.

Results

Of the 83 knees that had undergone previous irrigation and débridement, 28 (34%) failed subsequent two-stage revision and required reoperation for persistent infection.

Conclusions

The failure rate in this series of two-stage revisions for periprosthetic knee infection in patients treated with previous irrigation and débridement is considerably higher than previously reported failure rates of two-stage revision. Factors affecting the failure rate may include host quality, thoroughness of débridement, and organism virulence. Patients and surgeons must understand that irrigation and débridement, while initially attractive, may lead to high failure rates of subsequent two-stage reimplantation.

Level of Evidence

Level III, therapeutic study. See the guidelines online for a complete description of level of evidence.
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Metadata
Title
The Chitranjan Ranawat Award: Fate of Two-stage Reimplantation After Failed Irrigation and Débridement for Periprosthetic Knee Infection
Authors
J. Christopher Sherrell, MD
Thomas K. Fehring, MD
Susan Odum, MEd
Erik Hansen, MD
Benjamin Zmistowski, BS
Anne Dennos, BS
Niraj Kalore, MD
the Periprosthetic Infection Consortium
Publication date
01-01-2011
Publisher
Springer-Verlag
Published in
Clinical Orthopaedics and Related Research® / Issue 1/2011
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-010-1434-1

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