2023 ISAKOS Biennial Congress ePoster
Palliative Arthroscopic Debridement with Continuous Irrigation for the Infection TKA of High Mortality Risk Patients
Yoon Sang Jeon, MD, Seoul KOREA, REPUBLIC OF
Sung-Sahn Lee, MD., PhD., Goyangsi, Gyeonggido KOREA, REPUBLIC OF
Yoon Cheol Nam, MD, Incheon KOREA, REPUBLIC OF
Dong Jin Ryu, MD, PhD., Seoul KOREA, REPUBLIC OF
Inha University Hospital, Incheon, No State, KOREA, REPUBLIC OF
FDA Status Cleared
Summary
outcome of arthroscopic DAIR for high mortality patients
ePosters will be available shortly before Congress
Abstract
Background
Although two-stage revision surgery with an antibiotic-loaded cement spacer has recently been considered the gold standard with a high success rate, the overall mortality was 14.4-24 % at 2 years.
Arthroscopic DAIR for infection TKA appears to be an attractive alternative to the methods. However, arthroscopic DAIR has not been popularized because of concerns of lower infection eradication success rates than the open procedure or two- stage revision. This study aimed to evaluate the infection control rate of palliative arthroscopic debridement, antibiotics, and implant retention (DAIR) for the high mortality risk or terminal cancer stage patients.
Methods
From March 2018 to August 2021, 21 patients met the following inclusion criteria: old age of more than 80, diagnosed as a terminal stage of cancer, high risk of mortality and morbidity representing as Charlson comorbidity index (CCI) =5, Low daily activity with disabled extremity, re-infection after two-stage revision. Each patient underwent arthroscopic DAIR and additional continuous irrigation for 48hrs. The need for subsequent re-arthroscopic DAIR or two-stage revision was determined by the postoperative trends of C-reactive protein (CRP) levels. Infection control was defined as continuing controlled status of infection based on clinical and laboratory results by 1 or 2 times of arthroscopic DAIR within initial three months. Treatment failure was defined as more than three times arthroscopic debridement, two-stage revision surgery, or expired due to uncontrolled infection.
Results
Arthroscopic DAIR controlled the infection in 19 (90.5%) of the 21 cases. The other knee underwent a total of three times of re-arthroscopic DAIR and the other one underwent two-stage revision. Although five patients expired during the follow-up period due to worsening medical problems or terminal cancer, there were no deaths from uncontrolled infection, sepsis, or surgery-related complications.
Conclusions
Arthroscopic debridement with continuous irrigation for the infection TKA with high mortality risk or terminal cancer patients showed a 90.5% infection control rate. For high-risk patients, arthroscopic debridement with continuous irrigation can be an alternative treatment to improve the quality of life during survival.