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Large Joints Feature

Medical image of a 61-year-old male who presented to the emergency department with hip problems 43 months after having a titanium/titanium (Ti/Ti) modular neck-stem total hip arthroplasty .It was diagnosed as aseptic hip pneumarthrosis. This CT scan shows pneumarthrosis (gas in the joint). / Source: Wikimedia Commons and Yoav Morag, Corrie M. Yablon, Alexander E. Weber, Catherine Brandon, David J. Blaha

New Study: Early Irrigation Debridement vs. Joint Infection

Elizabeth Hofheinz, M.P.H., M.Ed. • Tue, February 6th, 2018

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According to a new study, two weeks may be the magic window for avoiding periprosthetic joint infection (PJI).

The research, “Irrigation and Debridement for Early Periprosthetic Knee Infection: Is It Effective?” appears in the January 9, 2018 edition of The Journal of Arthroplasty. The authors found that patients with early PJI who underwent irrigation and debridement (I&D) and liner exchange within two weeks of total knee arthroplasty (TKA) fared better than those who underwent the same treatment after the two week mark.

Ran Schwarzkopf, M.D. is with the Department of Orthopedic Surgery at New York University Langone Orthopedic Hospital. A co-author on the study, Dr. Schwarzkopf told OTW, “As infections continue to be the major reason for revision surgery after TKA as well as the cost to the patient emotionally and to the health system.”

The authors wrote, “From 2009-2017, retrospective review was performed of 55 knee PJI cases at our institution. All patients underwent polyethylene liner exchange and I&D for PJI…Average follow-up time after index-TKA was 2.5 years.”

“Among patients with I&D within 2-weeks of index-TXA, 14 patients (82%) were successfully treated while 3 (18%) had infection recurrence.”

“These outcomes were significantly improved compared to patients with I&D after 2-weeks: 19 (50%) successes and 19 (50%) failures. Staphylococcal species were the most frequent pathogen in patients treated before and after 2-weeks of index-TKA (39% and 50%, respectively)…”

Dr. Schwarzkopf commented to OTW, “As soon as there is a diagnosis of infection the patient should be considered for surgery as the results are better the sooner we operate and do the DAIR (debridement, exchange of modular parts, antibiotic treatment, and implant retention) procedure.”

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