Should Surgeons Debride Acutely Infected Joints?

    When a patient presents with an acute periprosthetic joint infection (PJI) following hip or knee arthroplasty, the traditional response has been to debride the wound, irrigate the joint, exchange the modular components, and then provide antibiotics.

    The problem is, this approach rarely works.

    Orthopaedic surgeons want irrigation and debridement (I&D) to succeed – and they may even say that in their practice, it does succeed.

    But the literature tells a different story, with success rates between 30% and 80%, depending on the duration of symptoms, the patient’s status, and possibly the infecting organism.

    The alternative to I&D is removal of the affected implant, and that, said Bryan D. Springer, MD, from OrthoCarolina, Charlotte, North Carolina, may seem too radical to the surgeon and the patient. So they become emotionally invested in a procedure that has disappointing results, as Dr. Springer pointed out.

    In response to the poor outcomes associated with I&D, Mark J. Spangehl, MD, from Mayo Clinic, Phoenix, Arizona, and his colleagues initiated a protocol about 10 years ago in which they do a 2-stage debridement with antibiotic-loaded beads. They have had generally positive results.

    At ICJR’s OrthoLIVE meeting, Dr. Springer and Dr. Spangehl debated the role of debridement in acute PJIs. We caught with them at the meeting and asked them for further comment on this issue.

    Click the images below to hear what they had to say.

    Mark J. Spangehl, MD: Results with antibiotic beads

    Mark J. Spangehl, MD: Patients who fail single-stage debridement

    Mark J. Spangehl, MD: Advantages of retaining components

    Mark J. Spangehl, MD: Recommending the technique

    Bryan D. Springer, MD: Case against debriding acute PJI

    Bryan D. Springer, MD: Drawbacks of antibiotic beads

    Bryan D. Springer, MD: Debriding an acute PJI

    Producer: Michael Szuch; Director: Michael Bugera; Post Production: Charles Maynard