Acute infection in total knee arthroplasty (TKA): Is early open débridement with polyethylene liner exchange (ODPLE) really effective?

Abstract

Background: Open débridement with polyethylene liner exchange (ODPLE) is an attractive strategy for the treatment of a total knee arthroplasty (TKA) with acute infection. Purpose: The purpose of this article is to review the literature on acute infection after TKA with the aim of answering the following four questions: 1) Is ODPLE really effective?; 2) What is the success rate of ODPLE?; 3) Which factors can predict control of TKA acute infection after early ODPLE?; 4) Is the success rate of two-stage revision for infection diminished after a failed early ODPLE?

Methods: The search engine was MedLine. The keywords used were: acute TKA infection. Fifty-three articles were found until 20 October 2015. Of those, only thirteen were selected and reviewed because they were strictly focused on the topic and the question of this article.

Results: Although the level of evidence of published papers is low, the mean success rate in postoperative acute infections ranged between 35% and 95%, and between 50% and 85% 70% in acute hematogenous infections. The only factor that can predict control of infection after ODPLE is the type of infected organism (Staphylococcus aureus 7% success rate, Staphylococcus epidermidis and Streptococcus species 47% success rate). The success rate of two-stage revision is diminished after a failed ODPLE (66% success rate).

Conclusions: ODPLE should be considered as a viable treatment option for acute prosthetic joint infection following TKA. The promptness of ODPLE is of paramount importance for success of the procedure.  In Staphylococcus aureus infections the mean success rate is 7%, while in Streptococcal or Staphylococcus epidermidis species the mean success rate is 47%. The success rate of two-stage revision for infection is diminished after a failed ODPLE (66% mean success rate). It seems that acute infections after TKA in the presence of Staphylococcus aureus must be treated by a two-stage revision arthroplasty.