Debridement with implant retention and postoperative continuous irrigation in the treatment of acute prosthetic joint infection after arthroplasty

[Objective]To assess the efficiency of debridement with implant retention and postoperative continuous irrigation in the treatment of acute prosthetic joint infection,and investigate the factors which may have influence on the result of the management. [Methods]We retrospectively collected data from 11 cases of acute prosthetic infection that were managed with debridement with implant retention and postoperative continuous irrigation from June 2003 to March 2009.Six cases were periprosthetic infections after total hip arthroplasty,and 5 cases were prosthetic joint infectione after total knee arthroplasty.In addition,there were 7 cases of early postoperative infection and 4 cases of hematogenous infection.Before the implant retention surgery,erythrocyte sedimentation rate,CRP and aspirated fluid culture were routinely conducted.When the debridement was carried out in hip,the joint was dislocated and all grossly infected and necrotic tissue was oberliterated.In the procedure of knee surgery,tibial polyethylene component was removed and replaced with a new one.Of the 11 cases,3 implant retention surgeries were performed at one week after onset of symptoms associated with acute infection.[Results]The mean follow-up was 41.4 months.There were 4 cases of early postoperative prosthetic infection and 2 of acute hematogenous infection that retained the prosthesis without further evidence of infection.The success rate was 54.5%.[Conclusion]Debridement with implant retention and operative continuous irrigation has a good therapeutic effect in the treatment of early postoperative prosthetic infection and acute hematogenous periprosthetic infection.If the surgery can be done within four weeks after onset of symptoms,some cases of infection may be controlled.The types and virulence of causative organisms have been implicated as a significant predictor of outcome.