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Palliative arthroscopic debridement with continuous irrigation for infected total knee arthroplasty in high mortality risk patients

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Abstract

Purpose

This study aimed to evaluate the infection control rate of palliative arthroscopic debridement, antibiotics, and implant retention (DAIR) for the high mortality risk or terminal cancer stage patients.

Methods

From March 2018 to August 2021, 21 patients met the following inclusion criteria: old age of more than 80, diagnosed as a terminal stage of cancer, high risk of mortality and morbidity representing as Charlson comorbidity index (CCI) ≥ 5, low daily activity with disabled extremity, and re-infection after two-stage revision. Each patient underwent arthroscopic DAIR and additional continuous irrigation for 48 hours. The need for subsequent re-arthroscopic DAIR or two-stage revision was determined by the post-operative trends of C-reactive protein (CRP) levels. Infection control was defined as continuing controlled status of infection based on clinical and laboratory results by one or two times of arthroscopic DAIR within initial two months. Treatment failure was defined as more than three times arthroscopic debridement, two-stage revision surgery, or expired due to uncontrolled infection.

Results

Arthroscopic DAIR controlled the infection in 19 (90.5%) of the 21 cases. The other knee underwent a total of three times of re-arthroscopic DAIR and the other one underwent two-stage revision. Although five patients expired during the follow-up period due to worsening medical problems or terminal cancer, there were no deaths from uncontrolled infection, sepsis, or surgery-related complications.

Conclusions

Arthroscopic debridement with continuous irrigation for the infection TKA with high mortality risk or terminal cancer patients showed a 90.5% infection control rate. For high-risk patients, arthroscopic debridement with continuous irrigation can be an alternative treatment to improve the quality of life during survival.

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Data availability

All data generated or analyzed during this study are included in this published article.

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Funding

This research was supported by the Inha University Hospital research grant.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Inha University Hospital, Inha University School of Medicine, Inhang-Ro 27, Jung-Gu, Incheon, 22322, South Korea

    Yoon Sang Jeon, Myung Ku Kim, Dae Gyu Kwon, Joo Won Park, Dong Seok Kang & Dong ** Ryu

  2. Department of Orthopaedic Surgery, Ilsan Paik Hospital, Inje University School of Medicine, Goyang-Si, Korea

    Sung-Sahn Lee

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  1. Yoon Sang Jeon
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  2. Myung Ku Kim
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  3. Dae Gyu Kwon
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  7. Dong ** Ryu
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Contributions

YS Jeon wrote the article with organizing the data; MK Kim participated in the design of the study and in the writing of the article in English. DG Kwon sorted the involved patients with a review of medial record. S Lee participated in the revision process. JW Park conceived the study and participated in its design. DS Kang wrote the article in English. DJ Ryu wrote the article with organizing the data and performed surgery.

Corresponding author

Correspondence to Dong ** Ryu.

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Ethics approval

The study was done in agreement with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by the investigational review board of our institution (IRB No. IUH 2022–05-004).

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For this retrospective study, informed consent was exempted by the investigational review board.

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Jeon, Y.S., Kim, M.K., Kwon, D.G. et al. Palliative arthroscopic debridement with continuous irrigation for infected total knee arthroplasty in high mortality risk patients. International Orthopaedics (SICOT) 47, 175–186 (2023). https://doi.org/10.1007/s00264-022-05632-6

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