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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 7/2019

01-07-2019 | Wound Debridement | KNEE

Negative impact of prior debridement on functional outcome of subsequent two-stage revision for early knee periprosthetic infection

Authors: Alejandro Lizaur-Utrilla, Alfredo Asensio-Pascual, Santiago Gonzalez-Parreño, Francisco A. Miralles-Muñoz, Fernando A. Lopez-Prats

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 7/2019

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Abstract

Purpose

To compare the functional outcome of two-stage revision (2SR) in patients without a prior debridement, antibiotics and implant retention with those patients who underwent 2SR after a failed debridement, antibiotics and implant retention for early periprosthetic joint infection following total knee arthroplasty (TKA). Negative impact of prior failed debridement, antibiotics and implant retention on the functional outcome of subsequent 2SR was hypothesized.

Methods

Case–control study of 49 patients initially treated with 2SR (group A) and 43 treated with 2SR after a prior failed debridement, antibiotics and implant retention (group B). Functional outcome was assessed by the Knee Society Scores (KSS) and Western Ontario and McMaster Universities (WOMAC) questionnaire. Range of motion (ROM) of the knee was also measured.

Results

The median follow-up was 4.1 (range 3–7) years. At final follow-up, KSS-knee (p = 0.001), KSS-function (p = 0.002), WOMAC-function (p = 0.022) and ROM (p = 0.002) were significantly better in the group A as compared to the group B. There was no significant difference between groups in the WOMAC-pain score (p = 0.597). In multivariate analysis, BMI < 30 (OR 3.1, 95% CI 1.7–4.9, p = 0.026), non- Staphylococcus causative microorganism (OR 2.7, 95% CI 1.6–5.9, p = 0.037), and 2SR procedure (OR 2.4, 95% CI 1.7–5.2, p = 0.018) were significant predictors of successful functional outcome.

Conclusions

A prior debridement, antibiotics and implant retention has been shown to have a negative impact on the functional outcome of a subsequent 2SR. These findings suggest that treatment with debridement, antibiotics and implant retention for early periprosthetic infection should only be used in selected patients, and the first option in those patients with Staphylococcus organisms should be 2SR.

Level of evidence

IV.
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Metadata
Title
Negative impact of prior debridement on functional outcome of subsequent two-stage revision for early knee periprosthetic infection
Authors
Alejandro Lizaur-Utrilla
Alfredo Asensio-Pascual
Santiago Gonzalez-Parreño
Francisco A. Miralles-Muñoz
Fernando A. Lopez-Prats
Publication date
01-07-2019
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 7/2019
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-019-05476-5

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