Risk Factors Leading to Failure of Irrigation and Liner Exchange in Acute Periprosthetic Joint Infections

Introduction: The number of joint replacement surgeries grows every year. With it, proportionally, grows the number of complications, including periprosthetic joint infections (PJI). The gold standard for acute infections, either early or late acute, is irrigation and debridement (I&D) with exchange of modular parts (liner in knees, head and liner in hips). We sought to identify the risk factors in those patients who fail this treatment.

Methods: A retrospective review of patient files in a large tertiary joint replacement referral center.

Results: Over the last ten years, 32 hips presented with acute PJI`s. Ten (31%) failed I&D. There were no demographic differences between the failure and success groups. 67% of all patients with methicillin-resistant staphylococcus strains failed I&D, compared to 12.5% of patients with methicillin-sensitive staphylococcus strains (p=0.01). There was a 40% prevalence of methicillin-resistant staphylococcus strains in the failure group, and only 4.5% in the success group (p=0.01). 50% of all diabetic patients failed I&D, compared to 20% of non-diabetic patients (p=0.08). There was a 60% prevalence of diabetes in the failure group, compared to 27% in the success group (p=0.07).

Conclusions: Methicillin resistance is a significant risk factor predicting failure of I&D for an acute PJI. In addition, there is a trend toward higher failure rates in patients with diabetes. Whether the two risk factors are independent or linked remains to be resolved. We suggest obtaining an antibiotic resistance profile prior to proceeding with I&D for an acute PJI, if clinically possible. In addition, a two-stage revision may be considered for some patients with diabetes due to a trend toward higher failure rates of I&D in this group.