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J Knee Surg 2020; 33(07): 623-628
DOI: 10.1055/s-0039-1683920
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Risk of Reinfection after Irrigation and Debridement of Acute Periprosthetic Joint Infection following TKA

James F. Baker
1   Department of Orthopaedic Surgery, University of Louisville, Louisville, Kentucky
,
Brian Dilworth
1   Department of Orthopaedic Surgery, University of Louisville, Louisville, Kentucky
,
Samrath J. Bhimani
1   Department of Orthopaedic Surgery, University of Louisville, Louisville, Kentucky
,
Kevin L. Ong
2   Biomedical Engineering Practice, Exponent Inc., Philadelphia, Pennsylvania
,
Edmund C. Lau
3   Health Sciences Group, Exponent Inc., Menlo Park, California
,
Langan S. Smith
4   KentuckyOne Health Medical Group, Louisville, Kentucky
,
Arthur L. Malkani
5   Adult Reconstruction Program, University of Louisville, KentuckyOne Health, Louisville, Kentucky
› Author Affiliations
Further Information

Publication History

20 July 2018

05 February 2019

Publication Date:
25 March 2019 (online)

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Abstract

The purpose of this study was to determine the risk factors associated with reinfection in patients treated with irrigation and debridement (I&D) with liner exchange for an acute (less than 3 months) prosthetic joint infection following the index primary total knee arthroplasty (TKA). Medicare claims database was queried to identify patients with periprosthetic joint infection within 3 months of their index TKA who underwent I&D with tibial polyethylene liner exchange. Exclusion criteria included age < 65 years and < 1 year of claims prior to TKA. A total of 341 patients met our criteria and were analyzed by age, sex, diabetes, obesity, Charlson comorbidity score, and time between TKA and I&D with liner exchange. Average time to I&D with liner exchange following primary TKA was 38.5 ± 21.3 days and multivariate analysis showed a significantly higher risk of reinfection within 1 year in patients > 85 years old (p < 0.001) and diabetes (p < 0.02). The risk of reinfection was lowest for patients treated with I&D with liner exchange within 14 days after TKA (p = 0.028). The incidence of reinfection was 223% greater if I&D with liner exchange was performed 2 to 4 weeks after primary TKA (p < 0.03), and 277% higher if performed > 6 weeks after index procedure compared with those performed within 2 weeks. Patients older than 85 years, diabetics, or treated with I&D with liner exchange > 14 days following the primary TKA had a significantly higher risk of reinfection within 1 year. Patients should be cautioned on the risk of reinfection prior to proceeding with I&D with liner exchange > 2 weeks following the index procedure.

Keywords

periprosthetic joint infection - total knee arthroplasty - irrigation and debridement
 

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