Author(s): Gerhard Maale, MD, Allen Reuben, MD, and Jorge Cases-Gamen; Dallas, TX
Title: One Stage Joint Revision for Infected Joints Using Radical Debridement and Antibiotic Cement
Purpose: The treatment of infected total joint replacements varies. Popular in the United States is a 2 stage debridement with placement of an intermediate antibiotic loaded cement spacer followed by definitive reconstruction at different timed intervals. Described in this study are the results of a one-stage revision after debridement for infected joints.
Methods: Seventy eight patients with 2 minimal year follow-up were treated by radical debridement,removal of the joint prosthesis, irrigation, changing of drapes and set-ups, re-irrigation and definitive exchange, were analyzed. All patients were pre-operatively imaged, and staged by the MSIS (Musculoskeletal Infection Society) staging as submitted by McPherson. Radical debridement was defined as removal of all dysvascular hard and soft tissue and removal of all prosthesis or related debris for which biofilm formation was possible. Cultures were analyzed and complications described.
Results: There were 45 total knees, 33 hips, 1 shoulder, and 1 elbow treated for infection. All patients had local or systemic compromising factors. Sixty six patients were stage IIIC3 by the MSIS Staging. Eight patients had relapse of their infection, 1 with bilateral knee infections were associated with an infected heart valve, done for palliation. An additional patient had a retained Marlex graft after prior pelvic floor reconstruction after resection of a tumor. If these cases were excluded, 93% remain clinically free of infection. The most common complications were subluxation or dislocation of the patella in total knees, and dislocation of total hip. Culture retrieval of organisms was low in patients having received prior antibiotics.
Discussion: These results for a one-stage treatment of infected joints are better or equal to other published treatment modalities for infected total joints. The results are not related to organism recovered. It is more function and cost effective than 2-stage procedures, and yield better results in our hands, 92 versus 84 percent eradication rates. The authors attribute the success to the thorough debridement with surgical removal of the biofilm.