Purpose
The purpose of this study was to assess the success rate of arthroscopic debridement
guided by C-reactive protein (CRP) levels for acutely infected total knee prostheses.
Methods
From January 2002 to December 2009, 16 consecutive eligible patients met the following
inclusion criteria: duration of symptoms less than 72 hours, previously well-functioning
prostheses, and no radiographic signs of loosening. Each patient underwent arthroscopy
with thorough debridement and synovectomy and copious irrigation. In addition to the
standard anterior portals, a posterior portal was used, and a drain was placed through
this portal. The need for subsequent open debridement was determined by the postarthroscopy
trends of CRP levels. Treatment success was defined as continuing freedom from infection
based on clinical and laboratory results, salvage of the prosthesis, and no evidence
of infection for at least 2 years.
Results
Arthroscopic debridement eradicated the infection in 10 (62.5%) of the 16 cases. The
other 6 knees (37.5%) underwent subsequent open debridement with polyethylene insert
exchange, which resulted in successful infection control with prosthetic salvage.
Conclusions
Patients who had undergone total knee arthroplasty (TKA) and had acute joint infection
for less than 72 hours with no evidence of a loosening prosthesis were treated by
arthroscopic debridement guided by the CRP level and had a 62.5% success rate with
arthroscopic treatment alone but a 100% success rate when initial failures were treated
with open debridement and polyethylene exchange.
Level of Evidence
Level IV, case series.
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Article info
Publication history
Published online: March 20, 2014
Accepted:
February 5,
2014
Received:
November 29,
2011
Footnotes
The authors report that they have no conflicts of interest in the authorship and publication of this article.
Identification
Copyright
© 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
