Failure of Irrigation and Débridement for Early Postoperative Periprosthetic Infection

Background Irrigation and débridement (I&D) of periprosthetic infection (PPI) is associated with infection control ranging from 16% to 47%. Mitigating factors include organism type, host factors, and timing of intervention. While the influence of organism type and host factors has been clarified, the timing of intervention remains unclear.

Questions/Purposes We addressed the following questions: What is the failure rate of I&Ds performed within 90 days of primary surgery? And what factors are associated with failure?

Methods We performed a multicenter retrospective analysis of I&D for PPI within 90 days of primary surgery. We included 86 patients (44 males, 42 females) with an average age of 61 years. Failure was defined as return to the operating room for an infection-related problem. We determined the failure rate of I&D within 90 days of primary surgery and whether the odds of rerevision for infection were associated with Charlson Comorbidity Index, age, sex, joint, organism type, and timing. The minimum followup was 24 months (average, 46 months; range, 24-106 months).

Results 54 of 86 patients (63%) failed. Eight of 10 (80%) failed within the first 10 days, 32 of 57 (56%) within 4 weeks, and 22 of 29 (76%) within 31 to 90 days postoperatively. No covariates were associated with subsequent revision surgery for infection.

Conclusions I&D for PPI is frequently used in the early postoperative period to control infection. While it is assumed early intervention will lead to control of infection in most cases, our data contradict this assumption.

Level of Evidence Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.