Timing From Admission to Debridement, Antibiotics, and Implant Retention Affects Treatment Success in Total Knee Arthroplasty Periprosthetic Joint Infection.

Abstract

Periprosthetic joint infection (PJI) represents a devastating complication associated with increased patient morbidity, mortality, and decreased quality of life. We devised the present study to assess the impact of timing from hospital admission to debridement, antibiotics, and implant retention (DAIR) for total knee arthroplasty (TKA) PJI on the affected patients' risk of reoperation for recalcitrant PJI, postoperative complications, readmission, and mortality. A search of our institutional PJI registry was conducted between 2008 and 2021 for patients having undergone DAIR following TKA at a minimum 2-year follow-up. The primary outcome assessed was reoperation for recalcitrant PJI. Secondary outcomes assessed were 90-day readmission, 90-day and 1-year mortality, and postoperative complications. Multivariate regression analyses were performed to determine the effect of variables on outcomes and reported as odds ratios (ORs) and confidence intervals (CIs), with P < 0.05 considered statistically significant. A total of 121 patients satisfied final inclusion criteria for this study, consisting of 89 primary TKAs and 22 revision TKAs. Multivariate regression analyses of our primary outcome demonstrated that time from admission to DAIR > 48 hours (OR: 22.2, 95% CI 2.1 to 229.7, P = 0.009), increase in pre-C-reactive protein by one (OR: 1.0, 95% CI 1.00 to 1.03, P = 0.01), and McPherson grade 2 versus grade 1 (OR: 11.4, 95% CI 1.8 to 72.6, P = 0.01) were associated with a substantial increase in risk for reoperation for PJI. Postoperative complications were positively associated with DAIR > 48 hours from admission (OR: 10.2%, CI 1.7 to 59.7, P = 0.01). The results of this study suggest that the timing of hospital admission to DAIR has a significant impact on reoperation for recalcitrant PJI and postoperative complications. Akin to the treatment of hip fractures, care should be provided within 48 h of admission to reduce treatment failure. In light of these findings, surgeons should advocate for rapid operating room access when performing DAIR in the treatment of TKA PJI.