Table 1.
Historical results for retention débridement of acute periprosthetic infections
| Author | Year | Study design | n | Number of infections controlled | Percent of infections controlled | Type of acute infection | Joints Treated | Maximum infection duration (days) | Surgical treatment | Average duration of parenteral antibiotics (range) | Average duration of oral antibiotics (range) | Number receiving long-term prophylactic oral antibiotics | Mean f/u (years) | Min f/u (years) | Max f/u (years) |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Schoifet and Morrey [22] | 1990 | retrospective | 21 | 5 | 23.8% | postoperative & hematogenous | TKA | 28 | open débridement | 4 wks (9–48 days) | 51 days (3–365 days) | none | 8.8 | 3 | 12 |
| Rasul et al. [21] | 1991 | retrospective | 7 | 3 | 42.9% | postoperative & hematogenous | TKA | 21 | open débridement with placement of antibiotic cement beads for 1–3 wks | 4–6 wks | not mentioned | not mentioned | 2 | 7 | |
| Burger et al. [3] | 1991 | retrospective | 23 | 7 | 30.4% | postoperative & hematogenous | TKA | 28 | open débridement | 5 wks (2–8 wks) | not mentioned | not mentioned | 3.5 | 2.5 | 4.8 |
| Hartman et al. [11] | 1991 | retrospective | 33 | 13 | 39.4% | postoperative & hematogenous | TKA | 28 | open débridement | 5.5 wks (2–12 wks) | unknown | unknown | 4.5 | 2 | 9 |
| McLaren and Spooner [14] | 1996 | retrospective | 4 | 4 | 100.0% | not mentioned | TKA | 35 | open debridement with placement of antibiotic–loaded cement, return to OR for repeat I&D, bead removal at 3 weeks | 6 wks | 6wks | none | 1.5 | 1.5 | 1.5 |
| Wasielewski et al. [28] | 1996 | retrospective | 8 | 6 | 75.0% | postoperative & hematogenous | TKA | 14 | open débridement | 6 wks (3–12 wks) | varied from “none to indefinite” | not mentioned | ~2.7 | 2 | |
| Tsukayama et al. [27] | 1996 | retrospective | 41 | 28 | 68.3% | postoperative & hematogenous | THA | 28 | open débridement | 4–6 wks | none | none | 2 | 6.7 | |
| Mont et al. [19] | 1997 | prospective | 24 | 20 | 83.3% | postoperative & hematogenous | TKA | 29 | 1–3 open débridements (knee cultured within 2 weeks; repeat debridement performed if cultures were positive) | 6 wks | none | none | 4 | 2 | 12 |
| Zimmerli et al. [29] | 1998 | randomized controlled trial | 8 | 8 | 100.0% | postoperative & hematogenous | THA & TKA | 21 | open débridement | 2 wks | 3–6 mo | none | 2 | ||
| Crockarell et al. [8] | 1998 | retrospective | 23 | 6 | 26.1% | postoperative & hematogenous | THA | 32 | open débridement (entire study group (including chronic infections) received an average of 2.2 débridement, range 1–17) | 4 wks (2–72 days) | (0–376 days) | 2 | 7.6 | 3.2 | 22 |
| Segawa et al. [23] | 1999 | retrospective | 17 | 10 | 58.8% | postoperative & hematogenous | TKA | 28 | open débridement with placement of antibiotic–loaded cement beads; 2 wks later beads removed through minimal incision. | 4–6 wks | not mentioned | not mentioned | ~3.5 | 2 | 8.8 |
| Meehan et al. [17] | 2003 | retrospective | 19 | 17 | 89.5% | hematogenous | THA & TKA | 10 | open débridement | 4 wks | variable | 8 | 6.1 | 1.2 | 21.8 |
| Deirmengian et al. [9] | 2003 | retrospective | 31 | 11 | 35.5% | postoperative & hematogenous | TKA | 28 | open débridement | 6 wks | not mentioned | 5 | 4 | 2 | 10 |
| Ilahi et al. [12] | 2005 | retrospective | 5 | 5 | 100.0% | hematogenous | TKA | 5 | open débridement | 6 wks | 2–4 wks | none | 3.4 | 3 | 3.6 |
| Chiu and Chen [4] | 2007 | prospective | 20 | 12 | 60.0% | postoperative & hematogenous | TKA | 28 | open débridement | at least 6 wks | none | none | 6.6 | 3.2 | 11.9 |
| Estes et al. [current study] | 2009 | retrospective | 20 | 18 | 90.0% | postoperative & hematogenous | THA & TKA | 16 | two-stage open débridement with antibiotic–loaded cement beads placed at first debridement | 6 wks | 9 mo | 8 | 3.5 | 1.2 | 7.5 |
Author = First author of study; n = number of acute infections treated with retention debridement; THA = total hip arthroplasty; TKA = total knee arthroplasty; wks = weeks; f/u = followup.