Etiology of acute periprosthetic joint infection and the results of its surgical treatment

Kliushin N.M., Ermakov A.M., Naumenko Z.S., Ababkov I.V., Triapichnikov A.S., Koiushkov A.N.

Abstract


Introduction
Surgical treatment of acute periprosthetic infection is possible with the technique of debridement and replacement of only modular components of the implant, provided that the implant is stable. Positive outcomes by using this technique in the acute infection phase range between 85 and 100 % while in the chronic phase they the success range is only 0–50 %. This is explained by the ability of bacteria to form biofilms on metal and polyethylene implant surfaces.
Material and methods
We conducted the analysis of the treatment results in 35 patients with acute periprosthetic infection of the hip and knee joints. They all had joint debridement with replacement of the modular components of their implants. The implant elements removed were examined for the presence of biofilms and its pathogenic microorganisms.
Results
Laboratory methods of investigation revealed that irreversible biofilm types were found on the surface of the removed components of the implants in all patients if periprosthetic infection was manifested for more than 2 weeks. Arrest of the infectious process was achieved only in 10 patients (66.7 %) with knee pathology and in 11 patients (55 %) with infected hip joint area.
Discussion
The main cause of acute postoperative and hematogenic infection of joints is an isolated gram-positive microflora, which is observed in more than 50 % of cases. Irreversible biofilm types on the surface of the implant components in the patients with the duration of periprosthetic infection for more than 2 weeks explain the high rate of purulent process recurrence which reaches 33.3 % after debridement in infected knees and 45 % after debridement in the hip joints.
Conclusion
It seems worth reviewing the indications for the technique of debridement by which not all the elements of the implant are changed and reduce its use if infection lasts for more than 2 weeks. However, this assumption requires further study.

Keywords


arthroplasty, knee joint, hip joint, periprosthetic infection, biofilm, microflora

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