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

Authors

  • 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
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.