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Success of Debridement, Antibiotics, and Implant Retention vs Revision In Early And Late Prosthetic Joint Infections Following Primary TKA: A Prospective, Multicenter Study of 251 Cases

Richard Rahardja, MBChB, BMedSc(Hons)
NEW ZEALAND

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Success of Debridement, Antibiotics, and Implant Retention vs Revision In Early And Late Prosthetic Joint Infections Following Primary TKA: A Prospective, Multicenter Study of 251 Cases

Mark Zhu, MBChB, NEW ZEALAND Richard Rahardja, MBChB, BMedSc(Hons), NEW ZEALAND Laurens Manning, MBChB, AUSTRALIA Sarah Metcalf, MBChB, NEW ZEALAND Simon W. Young, MD, FRACS, NEW ZEALAND

North Shore Hospital, Auckland, Auckland, NEW ZEALAND

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Anatomic Location

Knee

Diagnosis / Condition

Infection

Treatment / Technique

Arthroplasty

Summary: In PJIs occurring more than one year after the primary, staged revision is more effective than DAIR

Introduction

For surgeons treating prosthetic joint infection (PJI) in total knee arthroplasty (TKA), the indications for debridement, antibiotics and implant retention (DAIR) are unclear. The Auckland classification divides PJIs into “early” infections occurring within one year of primary, and “late” infections occurring after one year. Previous studies have demonstrated higher success rate of DAIR within one year of the primary arthroplasty. This study aimed to compare the success rate of DAIR vs revision in “early” and “late” infections to provide guidance for choosing the preferred treatment strategy.

Methods

The Prosthetic Joint Infection in Australia and New Zealand Observational (PIANO) is a prospective cohort study of PJIs between July 2014 and December 2017 in 27 hospitals across Australia and New Zealand. This study included PIANO patients with first time PJIs occurring after primary TKA. Baseline patient and surgical data were collected on patient enrolment and follow-up completed at 1- and 2-years. Treatment success was defined as the patient being alive, free from further revision and without clinical or microbiological evidence of reinfection at two years follow-up.

Patients were classified into the DAIR and Revision groups based on the treatment strategy selected. Patients with a sinus tract or treated with non-curative intent were excluded. “Early” and “late” infections were analyzed separately. Univariate analysis was performed to compare demographic and disease specific factors compared between the DAIR and Revision groups. Multivariate binary logistic regression was performed to identify whether treatment strategy and other risk factors were associated with treatment success in “early” and “late” infections.

Results

Of the 117 'early’ (<1 year) infections, 93 were initially managed with DAIR and 24 with revision. There were no differences in patient demographics (Age, gender, BMI, comorbidities) or disease factors (CRP on admission, organism type) between those treated with DAIR or revision. The DAIR group had a significantly greater proportion of patients with duration of symptoms less than 21 days (88.2% vs 45.8%, p<0.001). The treatment success rate was 56% in the DAIR group and 54% in the revision group for “early” infections (p=0.88). No independent risk factors were associated with treatment outcome on multivariate analysis.

Of 134 ‘late’ (>1 year) infections, 96 were initially managed with DAIR and 38 with revision. Patients in the DAIR group were more likely to have CRP>65 on presentation (89.6% vs 63.2%, p<0.001) and duration of symptoms <21days (91.7% vs 42.1%, p<0.001). The treatment success rate in “late” infections was 34.4% in the DAIR group and 60.5% in the Revision group (OR 3.07 p=0.006). On multivariate analysis, Revision was associated with 2.47x higher odds of treatment success (p=0.04) when compared to DAIR. Patients with at least one significant co-morbidity (OR 2.27, p=0.045) or with Staphylococcus aureus PJIs (OR 2.5, p=0.042) had higher odds of treatment failure.

Discussion And Conclusion

In “late” PJIs occurring greater than one year following primary TKA, a treatment strategy with revision rather than DAIR was associated with greater treatment success. Patients with significant comorbidities and Staphylococcus aureus PJIs were at higher risk of failure, regardless of treatment strategy.

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Preoperative Bone Marrow Edema Negatively Impacts Intermediate to Long-Term Outcomes after Unicompartmental Knee Arthroplasty ePoster Presentation Hong Yeol Yang, MD, PhD, KOREA, REPUBLIC OF Jong-Keun Seon, MD, PhD, Prof, KOREA, REPUBLIC OF
Central Sensitization is Associated with Persistent Postoperative Pain and Inferior Patient-Reported Outcomes in Patients Undergoing Unicompartmental Knee Arthroplasty ePoster Presentation Yong In, MD, PhD, KOREA, REPUBLIC OF Dongho Kwak, MD, KOREA, REPUBLIC OF Sungcheol Yang, MD, KOREA, REPUBLIC OF Hyukjin Jang, MD, KOREA, REPUBLIC OF Ryu Kyoung Cho, MD, KOREA, REPUBLIC OF Man-Soo Kim, MD, PhD, KOREA, REPUBLIC OF
Subtalar Joint Compensation using Full-length Standing Lower Extremity Anteroposterior Radiograph after Total Knee Arthroplasty for Varus Osteoarthritis in Nara Medical University Hospital with 2-year Follow-up ePoster Presentation Jerre Co De Guzman, MD, PHILIPPINES Munehiro Ogawa, MD, PhD, JAPAN Yusuke Ozaki, MD, JAPAN Yasuhito Tanaka, Prof., JAPAN Yuki Nishimura, MD, JAPAN Maria Elizabeth Mercado, MD, MAS, PHILIPPINES
Novel Technique For Surgeon-Placed Nerve Block And Continuous Nerve Block In Total Knee Arthroplasty. A Cadaveric Study ePoster Presentation Daniel E Matthews, MD, FAAOS, UNITED STATES
Does Robotic Assisted Unicompartmental Knee Arthroplasty Restore Native Jointline More Accurately Than With Conventional Instruments? ePoster Presentation Ashok Kumar Podhili Subramani, MS, INDIA Shantanu S. Patil, MBBS, MS(Orth), INDIA SAWAN PAWAR, MBBS MS (ORTH), INDIA Kalaivanan Kanniyan, MBBS MS Orth, INDIA karthik jayachandran, MS, INDIA PICHAI SURYANARAYAN, MBBS MS ORTH, INDIA
Palliative Arthroscopic Debridement with Continuous Irrigation for the Infection TKA of High Mortality Risk Patients ePoster Presentation Yoon Sang Jeon, MD, KOREA, REPUBLIC OF Sung-Sahn Lee, MD., PhD., KOREA, REPUBLIC OF Yoon Cheol Nam, MD, KOREA, REPUBLIC OF Dong Jin Ryu, MD, PhD., KOREA, REPUBLIC OF
Short Term Outcome of Tibial Defect Reconstruction In Primary Total Knee Arthroplasty: A Retrospective Study ePoster Presentation Sanjib Kumar Behera, MS (Orth), DNB (Rehab), DPMR, INDIA Madhumita Pradhan, BDS, MPH, MHA , INDIA Vikram Choudhary, MD, UNITED STATES
The Effect of Minor Adjustments to Tibial and Femoral Component Position on Soft Tissue Balance in Robotic Total Knee Arthroplasty ePoster Presentation Simon W. Young, MD, FRACS, NEW ZEALAND Matthew Carter, NEW ZEALAND Gavin William Clark, MBBS, FRACS, AUSTRALIA Christina Esposito, PhD, AUSTRALIA Matthew Walker, MBChB, FRACS, NEW ZEALAND
Phenotypic Differences In Coronal Alignment In Robot-Assisted Total Knee Arthroplasty Do Not Affect Patient-Reported Outcome Measurements In A Three-Dimensional Computed Tomography Analysis: A Single-Center Cohort Study ePoster Presentation Takao Kaneko, MD, PhD,, JAPAN Ayakane Yamamoto, MD, JAPAN Kazutaka Takada, MD, JAPAN Shu Yoshizawa, MD, JAPAN Hiroyasu Ikegami, MD, PhD, Prof., JAPAN
Combined Single-Shot Infiltration Between the Popliteal Artery and Capsule of the Knee and Adductor Canal Block with Bupivacaine, Dexmedetomidine, and Dexamethasone for Total Knee Arthroplasty: A Propensity-Matched Analysis ePoster Presentation David Freccero, MD, UNITED STATES Aneesh V Samineni, BA, UNITED STATES Seroos Salavati, MD, UNITED STATES
Compliance and Outcome of Osteoporosis Treatment After Total Knee Arthroplasty ePoster Presentation Yun Seong Choi, MD, KOREA, REPUBLIC OF Seung Hoon Lee, MD, KOREA, REPUBLIC OF Jung Ro Yoon, MD, KOREA, REPUBLIC OF Young Bin Shin, MD, KOREA, REPUBLIC OF Tae Hyuk Yoon, MD, KOREA, REPUBLIC OF
Advanced Active Robotic Technology for Total Knee Arthroplasty: A Learning Curve of Operative Time and Alignment Accuracy ePoster Presentation Yong-Beom Park, MD, PhD, KOREA, REPUBLIC OF Young-Bong Ko, MD, KOREA, REPUBLIC OF Dong-Hoon Lee, MD, KOREA, REPUBLIC OF Hyun-Chul Nam, MD, KOREA, REPUBLIC OF Seong-Hwan Kim, MD,Ph.D, MStat, KOREA, REPUBLIC OF
Influence of Mini Approach Instrumentation on Component Alignment In Unicondylar Knee Replacement ePoster Presentation Vinod Kumar, MBBS, MS, DNB, MNAMS, INDIA Deepak Gupta, MBBS, MS, INDIA Ananya Sharma, MBBS, MS, DNB , INDIA
A Prospective Randomised Study to Compare the Clinical and Radiological Outcomes of Functionally Aligned versus Mechanically Aligned Total Knee Arthroplasty with Robotic Arm Assistance ePoster Presentation Jai Thilak Kailathuvalapil, MS, MCh, FRCS, INDIA Amal Antony Paul, MBBS, INDIA
How to Measure Physical Function in Clinical Trials on Patients Undergoing Total or Partial Knee Arthroplasty? A Systematic Review ePoster Presentation Marco Adriani, MD, ITALY Roland Becker, MD, PhD, Prof., GERMANY Aleksandra Krolikowska, PhD, Prof., POLAND Krzysztof Lachowski, MD, GERMANY Robert Prill, PhD, GERMANY

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Success of Debridement, Antibiotics, and Implant Retention vs Revision In Early And Late Prosthetic Joint Infections Following Primary TKA: A Prospective, Multicenter Study of 251 Cases

Success of Debridement, Antibiotics, and Implant Retention vs Revision In Early And Late Prosthetic Joint Infections Following Primary TKA: A Prospective, Multicenter Study of 251 Cases

Introduction

Methods

Results

Discussion And Conclusion

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Success of Debridement, Antibiotics, and Implant Retention vs Revision In Early And Late Prosthetic Joint Infections Following Primary TKA: A Prospective, Multicenter Study of 251 Cases

Success of Debridement, Antibiotics, and Implant Retention vs Revision In Early And Late Prosthetic Joint Infections Following Primary TKA: A Prospective, Multicenter Study of 251 Cases

Introduction

Methods

Results

Discussion And Conclusion

More 2023 ISAKOS Congress Content