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World J Orthop. Sep 18, 2016; 7(9): 546-552
Published online Sep 18, 2016. doi: 10.5312/wjo.v7.i9.546
Implant retention after acute and hematogenous periprosthetic hip and knee infections: Whom, when and how?
Georgios K Triantafyllopoulos, Vasileios Soranoglou, Stavros G Memtsoudis, Lazaros A Poultsides
Georgios K Triantafyllopoulos, Vasileios Soranoglou, Lazaros A Poultsides, Department of Orthopaedic Surgery, Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY 10021, United States
Stavros G Memtsoudis, Department of Anesthesiology, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY 10021, United States
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: The authors have no potential conflicts of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Lazaros A Poultsides, MD, MSc, PhD, Department of Orthopaedic Surgery, Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th Street, New York, NY 10021, United States. poultsidesl@hss.edu
Telephone: +1-212-7742387 Fax: +1-646-7978939
Received: April 25, 2016
Peer-review started: April 26, 2016
First decision: June 16, 2016
Revised: June 23, 2016
Accepted: July 11, 2016
Article in press: July 13, 2016
Published online: September 18, 2016
Processing time: 139 Days and 23.6 Hours
Abstract

Periprosthetic joint infections (PJI) of the hip and the knee are grossly classified as early post-operative, acute hematogenous and late chronic infections. Whereas two-stage exchange arthroplasty is the standard of care in North America for treating chronic infections, irrigation and debridement (I and D) with retention of implants has been used in an attempt to treat the other two types of PJIs. The rationale of this approach is that a PJI may be eradicated without the need of explanting the prostheses, as long as it has not transitioned into a chronic state. With the present paper, we review current evidence regarding the role of I and D with implant retention for treating PJIs of the hip and the knee. While a very wide range of success rates is reported in different studies, a short period of time between initiation of symptoms and intervention seems to play a prominent role with regards to a successful outcome. Moreover, pathogens of higher virulence and resistance to antibiotics are associated with a poorer result. Specific comorbidities have been also correlated with a less favorable outcome. Finally, one should proceed with serial I and Ds only under the condition that a predefined, aggressive protocol is applied. In conclusion, when treating a PJI of the hip or the knee, all the above factors should be considered in order to decide whether the patient is likely to benefit from this approach.

Keywords: Irrigation and debridement; Periprosthetic infection; Total knee arthroplasty; Implant retention; Total hip arthroplasty

Core tip: An infected total joint arthroplasty represents a significant burden to patients, as well as to orthopaedic surgeons. Previously, irrigation and debridement with retention of implants has been advocated for certain types of periprosthetic infections. The purpose of the present paper is to review the indications, success rates and factors determining the outcome of this treatment option for periprosthetic infections of the hip and the knee.