Periprosthetic knee sepsis. The role of irrigation and debridement

Thirty-three infected total knee arthroplasties were treated by irrigation, debridement, and intravenous antibiotics. These cases were retrospectively reviewed with an average follow-up period of 4.5 years. There were 12 revisions and 21 primary arthroplasties in the series. Thirty-two knees were openly irrigated and debrided, and one was arthroscopically treated. In 20 of 33 knees, infection recurred--a reinfection rate of 61%. The authors attempted to identify factors influencing success and failure of infection eradication. There was a statistically significant improvement in the success rate of knees irrigated and debrided within four weeks of index surgery (p less than .05). No statistically significant correlation was found between success and failure with regard to gender, age, preoperative diagnosis, previous surgery, length of intravenous antibiotics, or time from clinical symptoms to debridement. The authors believe that irrigation and debridement have a role in the immediate postoperative period. Caution should be used in periprosthetic knee infection appearing greater than four weeks from index surgery.