Publication details

Léčba periprotetické infekce pomocí débridement s ponecháním implantátu

Title in English Periprosthetic infection treatment with débridement and implant retention


Year of publication 2017
Type Article in Periodical
Magazine / Source Ortopedie
MU Faculty or unit

Faculty of Medicine

Keywords total hip arthroplasty; total knee arthroplasty; infection; débridement with arthroplasty retention
Description Introduction: Periprosthetic infection is a potentially devastating complication. A two-stage procedure is the “gold standard” for treatment of such infections, however there is still the burden of higher morbidity and has inferior functional results in comparison to treatment with debridement and retention of endoprosthesis. Debridement with retention of arthroplasty is assumed to be an appropriate alternative in indicated cases. Material and Methods: We treated 63 patients with this method between the years 2000 – 2015 at our department. 38 patients had an infected total knee endoprosthesis and 25 had an infected total knee arthroplasty. We evaluate retrospectively the relationship between success of treatment with debridement and retention of arthroplasty and the type of implant, the type of infection according to Tsukayama, the type of infectious agent and the interval between the onset of the symptoms and commencement of the treatment along with the type of joint treatment. Results: With the aforementioned method, we succeeded in eradicating infection in 31 patients (49 %). We didn’t found out significant differences in treatment success based on the surveyed parameters, apart from a link between the success of the treatment and the time interval between onset of the symptoms and treatment (p= 0.044). In the group where all indication criteria and preferred type of treatment were met (treatment to 10 days, Gram positive infection, type II or III according to Tsukayama, open revision, irrigation with povidon iodine or treatment with antibiotic foam, change of mobile parts of endoprosthesis) the success rate was 82 %. In the group where one or more of the criteria wasn’t met, the success rate was 31%. The difference between the groups was statically significant (p= 0.028). There were three patients in the group treated with debridement and retention in which treatment ended with a fatal result, in comparison to the group of primarily extracted infected implants (no fatal result). The difference is statistically significant (p= 0.0495). Discussion: Infection treatment with debridement and implant retention is a convenient alternative of periprosthetic infection treatment. Success rate could be around 80 % when correct indication criteria are met and treatment procedure is carried out correctly. Without meeting the proper criteria, the treatment could lead to fatal results for the patient.

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