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High Rate of Intramedullary Canal Culture Positivity in Total Knee Arthroplasty Resection for Prosthetic Joint
Murillo Adrados1, Brian M Curtin1, Bryan D Springer2
1OrthoCarolina-Hip & Knee Center, Charlotte, North Carolina.
Background:
Periprosthetic infection is a devastating complication following total knee arthroplasty. A 2-stage protocol often includes an interim antibiotic spacer with intramedullary (IM) dowels. However, the necessity of IM dowels has recently been challenged. Specifically, the data supporting bacterial colonization of the IM canal are limited and controversial. The purpose of this study was to identify the rate of positive IM cultures during resection arthroplasty in periprosthetic knee infection.
Methods:
A total of 66 IM diaphyseal cultures were taken during resection arthroplasty from 34 patients diagnosed with periprosthetic knee infection. These IM cultures were taken from the femoral and tibial canals using separate sterile instruments. All patients had infected primary total knee arthroplasty implants at the time of resection.
Results:
Thirty one percent (n = 21) of IM canal cultures in this study were positive from either the tibial or the femoral diaphysis at the time of resection arthroplasty. There were 18 of 21 (86%) of the positive IM canal cultures with concordant intraoperative joint cultures where the IM cultures matched the intraarticular cultures.
Conclusion:
With a 31% positive IM canal culture rate, this study confirms the logic of using IM dowels with an antibiotic spacer to treat periprosthetic knee infection. Since the failure of a 2-stage reimplantation is catastrophic, any attempt to provide additional local antibiotic delivery seems warranted. Since nearly one-third of our patients had positive IM cultures, this simple addition to an antibiotic spacer has the potential to improve 2-stage results. Claims supporting the elimination of IM dowels during resection arthroplasty seem ill-advised.
Insights
Periprosthetic knee infections can be treated with antibiotic spacers and intramedullary (IM) dowels. This study found a 31% positive IM canal culture rate, supporting the use of IM dowels in two-stage protocols.
Area of Science:
- Orthopedics
- Infectious Disease
- Surgical Innovation
Background:
- Periprosthetic joint infection is a severe complication after total knee arthroplasty.
- Two-stage revision protocols often utilize antibiotic-loaded spacers with intramedullary (IM) dowels.
- The necessity of IM dowels in these protocols is debated due to limited data on intramedullary canal bacterial colonization.
Purpose of the Study:
- To determine the rate of positive intramedullary (IM) canal cultures during resection arthroplasty for periprosthetic knee infection.
- To evaluate the necessity and efficacy of IM dowels in the management of periprosthetic knee infections.
Main Methods:
- A total of 66 intramedullary (IM) diaphyseal cultures were obtained during resection arthroplasty in 34 patients with periprosthetic knee infection.
- Cultures were taken from both the femoral and tibial canals using separate sterile instruments.
- All patients had infected primary total knee arthroplasty implants at the time of the resection surgery.
Main Results:
- Thirty-one percent (21 of 66) of IM canal cultures yielded positive bacterial growth.
- Of the positive IM cultures, 86% (18 of 21) showed concordance with intraoperative joint cultures.
- This indicates a significant rate of bacterial presence within the IM canal during periprosthetic knee infection.
Conclusions:
- The 31% positive IM canal culture rate supports the continued use of intramedullary (IM) dowels with antibiotic spacers in two-stage periprosthetic knee infection treatment.
- The addition of IM dowels offers potential for improved outcomes by providing additional local antibiotic delivery.
- Eliminating IM dowels in resection arthroplasty for periprosthetic knee infection may be premature given the observed bacterial colonization rates.
