[V.A.C.-instill therapy in periprosthetic infection of hip and knee arthroplasty]

Periprosthetic infection represents a main complication of arthroplasty. In case of an early infection the implant often can be left in place. Whether instillation of antiseptic solution using a reticulated sponge in combination with negative pressure wound therapy (V.A.C.-Instill) can be useful was the aim of our investigation. Up to now the instillation of Lavasept in combination with negative pressure wound therapy could be performed in three patients. In two cases an early infection of a hip prosthesis and one infected knee implant had to be treated. Following surgical debridement V.A.C.-Instill therapy was performed for 4-7 days followed by closure of the wound or a repeated application. Lavasept was used for irrigation. In all three cases retention of the primary implant could be achieved. The follow up now is 8 to 22 weeks. No recurrence of the infection occurred. After salvage of the prosthesis the joint allowed full load bearing and painfree mobilisation. The V.A.C.-Instill system proved to be easy to use. With this system early periprosthetic infection with antiseptic irrigation in combination with negative pressure wound therapy decreasing the bacterial burden, salvage of prosthesis seems to be possible. The therapy is applicable in hip and knee prosthesis. Final conclusions about this therapy however can be done only after a larger series of patients.