Arthroscopic debridement for acutely infected prosthetic knee: any role for infection control and prosthesis salvage?

Abstract

PURPOSE: The purpose of this study was to assess the success rate of arthroscopic

debridement guided by C-reactive protein (CRP) levels for acutely infected total

knee prostheses. METHODS: From January 2002 to December 2009, 16 consecutive

eligible patients met the following inclusion criteria: duration of symptoms less

than 72 hours, previously well-functioning prostheses, and no radiographic signs

of loosening. Each patient underwent arthroscopy with thorough debridement and

synovectomy and copious irrigation. In addition to the standard anterior portals,

a posterior portal was used, and a drain was placed through this portal. The need

for subsequent open debridement was determined by the postarthroscopy trends of

CRP levels. Treatment success was defined as continuing freedom from infection

based on clinical and laboratory results, salvage of the prosthesis, and no

evidence of infection for at least 2 years. RESULTS: Arthroscopic debridement

eradicated the infection in 10 (62.5%) of the 16 cases. The other 6 knees (37.5%)

underwent subsequent open debridement with polyethylene insert exchange, which

resulted in successful infection control with prosthetic salvage. CONCLUSIONS:

Patients who had undergone total knee arthroplasty (TKA) and had acute joint

infection for less than 72 hours with no evidence of a loosening prosthesis were

treated by arthroscopic debridement guided by the CRP level and had a 62.5%

success rate with arthroscopic treatment alone but a 100% success rate when

initial failures were treated with open debridement and polyethylene exchange.

LEVEL OF EVIDENCE: Level IV, case series.