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International Orthopaedics

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19-11-2022 | Wound Debridement | Original Paper

Palliative arthroscopic debridement with continuous irrigation for infected total knee arthroplasty in high mortality risk patients

Authors: Yoon Sang Jeon, Myung Ku Kim, Dae Gyu Kwon, Sung-Sahn Lee, Joo Won Park, Dong Seok Kang, Dong Jin Ryu

Published in: International Orthopaedics | Issue 1/2023

Abstract

Purpose

This study aimed to evaluate the infection control rate of palliative arthroscopic debridement, antibiotics, and implant retention (DAIR) for the high mortality risk or terminal cancer stage patients.

Methods

From March 2018 to August 2021, 21 patients met the following inclusion criteria: old age of more than 80, diagnosed as a terminal stage of cancer, high risk of mortality and morbidity representing as Charlson comorbidity index (CCI) ≥ 5, low daily activity with disabled extremity, and re-infection after two-stage revision. Each patient underwent arthroscopic DAIR and additional continuous irrigation for 48 hours. The need for subsequent re-arthroscopic DAIR or two-stage revision was determined by the post-operative trends of C-reactive protein (CRP) levels. Infection control was defined as continuing controlled status of infection based on clinical and laboratory results by one or two times of arthroscopic DAIR within initial two months. Treatment failure was defined as more than three times arthroscopic debridement, two-stage revision surgery, or expired due to uncontrolled infection.

Results

Arthroscopic DAIR controlled the infection in 19 (90.5%) of the 21 cases. The other knee underwent a total of three times of re-arthroscopic DAIR and the other one underwent two-stage revision. Although five patients expired during the follow-up period due to worsening medical problems or terminal cancer, there were no deaths from uncontrolled infection, sepsis, or surgery-related complications.

Conclusions

Arthroscopic debridement with continuous irrigation for the infection TKA with high mortality risk or terminal cancer patients showed a 90.5% infection control rate. For high-risk patients, arthroscopic debridement with continuous irrigation can be an alternative treatment to improve the quality of life during survival.

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Title: Palliative arthroscopic debridement with continuous irrigation for infected total knee arthroplasty in high mortality risk patients
Authors: Yoon Sang Jeon
Myung Ku Kim
Dae Gyu Kwon
Sung-Sahn Lee
Joo Won Park
Dong Seok Kang
Dong Jin Ryu
Publication date: 19-11-2022
Publisher: Springer Berlin Heidelberg
Keywords: Wound Debridement
Antibiotic
Published in: International Orthopaedics / Issue 1/2023
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-022-05632-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Palliative arthroscopic debridement with continuous irrigation for infected total knee arthroplasty in high mortality risk patients

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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