A Two-stage Retention Débridement Protocol for Acute Periprosthetic Joint Infections
Identifieur interne : 000B14 ( Pmc/Corpus ); précédent : 000B13; suivant : 000B15A Two-stage Retention Débridement Protocol for Acute Periprosthetic Joint Infections
Auteurs : Chris S. Estes ; Chris P. Beauchamp ; Henry D. Clarke ; Mark J. SpangehlSource :
- Clinical Orthopaedics and Related Research [ 0009-921X ] ; 2010.
Abstract
Due to the historically poor infection control rates with débridement and component retention for acute periprosthetic infections we developed a new approach for treating acute periprosthetic total joint infections: initial débridement with prosthesis retention and placement of antibiotic-impregnated cement beads followed by a second débridement within 7 days, at which time the beads are removed and new modular parts inserted. Intravenous antibiotics were used for 6 weeks followed by oral antibiotics. Depending on the clinical situation, antibiotics are discontinued or in selected patients continued indefinitely.
We determined the ability of this two-stage débridement to control infection.
We retrospectively reviewed the charts of 20 patients who underwent this technique; 2 had postoperative and 18 had hematogenous infections. The primary outcome measure was the infection control. The minimum followup was 1 year (mean, 3.5 years; range, 1.2–7.5 years).
Two of the 20 patients had persistent infection. There were no failures in the acute postoperative group (0 of 2) and two of 18 in the acute hematogenous group. Of the 18 patients without evidence of persistent infection, 10 were no longer on antibiotics at the most recent followup and eight were treated with long-term antibiotics due to compromised host status.
The control of infection in 18 of 20 patients using this technique compares favorably with historical success rates, which range from 24% to 100%. Further research is required to analyze the individual contribution of débridement technique, the use of serial débridements, local depot antibiotics, and combination antibiotic therapy on short-term infection control rates and the long-term persistent control of periprosthetic infection.
Level IV, therapeutic study. See the Guidelines for Authors for a complete description of level of evidence.
Url:
DOI: 10.1007/s11999-010-1293-9
PubMed: 20224958
PubMed Central: 2895840
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PMC:2895840Le document en format XML
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<author><name sortKey="Estes, Chris S" sort="Estes, Chris S" uniqKey="Estes C" first="Chris S." last="Estes">Chris S. Estes</name>
<affiliation><nlm:aff id="Aff1">Banner Good Samaritan Orthopaedic Residency Program, Phoenix, AZ USA</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="Aff2">Mayo Clinic Arizona, 5777 East Mayo Blvd, Phoenix, AZ 85054 USA</nlm:aff>
</affiliation>
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<author><name sortKey="Beauchamp, Chris P" sort="Beauchamp, Chris P" uniqKey="Beauchamp C" first="Chris P." last="Beauchamp">Chris P. Beauchamp</name>
<affiliation><nlm:aff id="Aff2">Mayo Clinic Arizona, 5777 East Mayo Blvd, Phoenix, AZ 85054 USA</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Clarke, Henry D" sort="Clarke, Henry D" uniqKey="Clarke H" first="Henry D." last="Clarke">Henry D. Clarke</name>
<affiliation><nlm:aff id="Aff2">Mayo Clinic Arizona, 5777 East Mayo Blvd, Phoenix, AZ 85054 USA</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Spangehl, Mark J" sort="Spangehl, Mark J" uniqKey="Spangehl M" first="Mark J." last="Spangehl">Mark J. Spangehl</name>
<affiliation><nlm:aff id="Aff2">Mayo Clinic Arizona, 5777 East Mayo Blvd, Phoenix, AZ 85054 USA</nlm:aff>
</affiliation>
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<idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2895840</idno>
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<idno type="doi">10.1007/s11999-010-1293-9</idno>
<date when="2010">2010</date>
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">A Two-stage Retention Débridement Protocol for Acute Periprosthetic Joint Infections</title>
<author><name sortKey="Estes, Chris S" sort="Estes, Chris S" uniqKey="Estes C" first="Chris S." last="Estes">Chris S. Estes</name>
<affiliation><nlm:aff id="Aff1">Banner Good Samaritan Orthopaedic Residency Program, Phoenix, AZ USA</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="Aff2">Mayo Clinic Arizona, 5777 East Mayo Blvd, Phoenix, AZ 85054 USA</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Beauchamp, Chris P" sort="Beauchamp, Chris P" uniqKey="Beauchamp C" first="Chris P." last="Beauchamp">Chris P. Beauchamp</name>
<affiliation><nlm:aff id="Aff2">Mayo Clinic Arizona, 5777 East Mayo Blvd, Phoenix, AZ 85054 USA</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Clarke, Henry D" sort="Clarke, Henry D" uniqKey="Clarke H" first="Henry D." last="Clarke">Henry D. Clarke</name>
<affiliation><nlm:aff id="Aff2">Mayo Clinic Arizona, 5777 East Mayo Blvd, Phoenix, AZ 85054 USA</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Spangehl, Mark J" sort="Spangehl, Mark J" uniqKey="Spangehl M" first="Mark J." last="Spangehl">Mark J. Spangehl</name>
<affiliation><nlm:aff id="Aff2">Mayo Clinic Arizona, 5777 East Mayo Blvd, Phoenix, AZ 85054 USA</nlm:aff>
</affiliation>
</author>
</analytic>
<series><title level="j">Clinical Orthopaedics and Related Research</title>
<idno type="ISSN">0009-921X</idno>
<idno type="eISSN">1528-1132</idno>
<imprint><date when="2010">2010</date>
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<front><div type="abstract" xml:lang="en"><sec><title>Background</title>
<p>Due to the historically poor infection control rates with débridement and component retention for acute periprosthetic infections we developed a new approach for treating acute periprosthetic total joint infections: initial débridement with prosthesis retention and placement of antibiotic-impregnated cement beads followed by a second débridement within 7 days, at which time the beads are removed and new modular parts inserted. Intravenous antibiotics were used for 6 weeks followed by oral antibiotics. Depending on the clinical situation, antibiotics are discontinued or in selected patients continued indefinitely.</p>
</sec>
<sec><title>Questions/purposes</title>
<p>We determined the ability of this two-stage débridement to control infection.</p>
</sec>
<sec><title>Methods</title>
<p>We retrospectively reviewed the charts of 20 patients who underwent this technique; 2 had postoperative and 18 had hematogenous infections. The primary outcome measure was the infection control. The minimum followup was 1 year (mean, 3.5 years; range, 1.2–7.5 years).</p>
</sec>
<sec><title>Results</title>
<p>Two of the 20 patients had persistent infection. There were no failures in the acute postoperative group (0 of 2) and two of 18 in the acute hematogenous group. Of the 18 patients without evidence of persistent infection, 10 were no longer on antibiotics at the most recent followup and eight were treated with long-term antibiotics due to compromised host status.</p>
</sec>
<sec><title>Conclusions</title>
<p>The control of infection in 18 of 20 patients using this technique compares favorably with historical success rates, which range from 24% to 100%. Further research is required to analyze the individual contribution of débridement technique, the use of serial débridements, local depot antibiotics, and combination antibiotic therapy on short-term infection control rates and the long-term persistent control of periprosthetic infection.</p>
</sec>
<sec><title>Level of Evidence</title>
<p> Level IV, therapeutic study. See the Guidelines for Authors for a complete description of level of evidence.</p>
</sec>
</div>
</front>
</TEI>
<pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Clin Orthop Relat Res</journal-id>
<journal-title-group><journal-title>Clinical Orthopaedics and Related Research</journal-title>
</journal-title-group>
<issn pub-type="ppub">0009-921X</issn>
<issn pub-type="epub">1528-1132</issn>
<publisher><publisher-name>Springer-Verlag</publisher-name>
<publisher-loc>New York</publisher-loc>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">20224958</article-id>
<article-id pub-id-type="pmc">2895840</article-id>
<article-id pub-id-type="publisher-id">1293</article-id>
<article-id pub-id-type="doi">10.1007/s11999-010-1293-9</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Symposium: Papers Presented at the 2009 Meeting of the Musculoskeletal Infection Society</subject>
</subj-group>
</article-categories>
<title-group><article-title>A Two-stage Retention Débridement Protocol for Acute Periprosthetic Joint Infections</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Estes</surname>
<given-names>Chris S.</given-names>
</name>
<degrees>DO</degrees>
<xref ref-type="aff" rid="Aff1">1</xref>
<xref ref-type="aff" rid="Aff2">2</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Beauchamp</surname>
<given-names>Chris P.</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="Aff2">2</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Clarke</surname>
<given-names>Henry D.</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="Aff2">2</xref>
</contrib>
<contrib contrib-type="author" corresp="yes"><name><surname>Spangehl</surname>
<given-names>Mark J.</given-names>
</name>
<degrees>MD</degrees>
<address><email>spangehl.mark@mayo.edu</email>
</address>
<xref ref-type="aff" rid="Aff2">2</xref>
</contrib>
<aff id="Aff1"><label>1</label>
Banner Good Samaritan Orthopaedic Residency Program, Phoenix, AZ USA</aff>
<aff id="Aff2"><label>2</label>
Mayo Clinic Arizona, 5777 East Mayo Blvd, Phoenix, AZ 85054 USA</aff>
</contrib-group>
<pub-date pub-type="epub"><day>12</day>
<month>3</month>
<year>2010</year>
</pub-date>
<pub-date pub-type="ppub"><month>8</month>
<year>2010</year>
</pub-date>
<volume>468</volume>
<issue>8</issue>
<fpage>2029</fpage>
<lpage>2038</lpage>
<permissions><copyright-statement>© The Association of Bone and Joint Surgeons® 2010</copyright-statement>
</permissions>
<abstract id="Abs1"><sec><title>Background</title>
<p>Due to the historically poor infection control rates with débridement and component retention for acute periprosthetic infections we developed a new approach for treating acute periprosthetic total joint infections: initial débridement with prosthesis retention and placement of antibiotic-impregnated cement beads followed by a second débridement within 7 days, at which time the beads are removed and new modular parts inserted. Intravenous antibiotics were used for 6 weeks followed by oral antibiotics. Depending on the clinical situation, antibiotics are discontinued or in selected patients continued indefinitely.</p>
</sec>
<sec><title>Questions/purposes</title>
<p>We determined the ability of this two-stage débridement to control infection.</p>
</sec>
<sec><title>Methods</title>
<p>We retrospectively reviewed the charts of 20 patients who underwent this technique; 2 had postoperative and 18 had hematogenous infections. The primary outcome measure was the infection control. The minimum followup was 1 year (mean, 3.5 years; range, 1.2–7.5 years).</p>
</sec>
<sec><title>Results</title>
<p>Two of the 20 patients had persistent infection. There were no failures in the acute postoperative group (0 of 2) and two of 18 in the acute hematogenous group. Of the 18 patients without evidence of persistent infection, 10 were no longer on antibiotics at the most recent followup and eight were treated with long-term antibiotics due to compromised host status.</p>
</sec>
<sec><title>Conclusions</title>
<p>The control of infection in 18 of 20 patients using this technique compares favorably with historical success rates, which range from 24% to 100%. Further research is required to analyze the individual contribution of débridement technique, the use of serial débridements, local depot antibiotics, and combination antibiotic therapy on short-term infection control rates and the long-term persistent control of periprosthetic infection.</p>
</sec>
<sec><title>Level of Evidence</title>
<p> Level IV, therapeutic study. See the Guidelines for Authors for a complete description of level of evidence.</p>
</sec>
</abstract>
<custom-meta-group><custom-meta><meta-name>issue-copyright-statement</meta-name>
<meta-value>© The Association of Bone and Joint Surgeons® 2010</meta-value>
</custom-meta>
</custom-meta-group>
</article-meta>
</front>
</pmc>
</record>
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