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Arch Orthop Trauma Surg. 2011 Sep;131(9):1233-8. doi: 10.1007/s00402-011-1291-8. Epub 2011 Mar 9.

Comparison of a low-pressure and a high-pressure pulsatile lavage during débridement for orthopaedic implant infection.

Author information

1
Department of Orthopaedic and Trauma Surgery, Bone and Joint Infection Unit, Hospital Clínic of Barcelona, University of Barcelona, Spain. e.munoz.mahamud@gmail.com

Abstract

INTRODUCTION:

The aim of our study was to compare the effectiveness of high-pressure pulsatile lavage and low-pressure lavage in patients with an orthopaedic implant infection treated with open débridement followed by antibiotic treatment.

PATIENTS AND METHODS:

Patients with an orthopaedic implant infection requiring open débridement from January 2008 to August 2009 were randomized prospectively to a low-pressure or a high-pressure pulsatile lavage arm. Relevant information about demographics, co-morbidity, type of implant, microbiology data, surgical treatment, and outcome were recorded. Comparison of proportions was made using χ(2) test or Fisher exact test when necessary. The Kaplan-Meier survival method was used to estimate the cumulative probability of treatment failure from open débridement to the last visit.

RESULTS:

Seventy-nine patients were included. There were no differences between the main characteristics between both groups (p > 0.05). Mean (SD) age of the whole cohort was 70.2 (11.9) years. There were 46 infections on knee prosthesis, 17 on hip prosthesis, 7 on hip hemiarthroplasties and 9 on osteosynthesis devices. There were 69 acute post-surgical infections, 8 acute haematogenous infections and 2 chronic infections. The most common microorganisms isolated were coagulase-negative Staphylococci in 34 cases, Staphylococcus aureus in 26 and Escherichia coli in 19 cases. There were 30 polymicrobial infections. A total of 42 and 37 patients were randomized to a high-pressure pulsatile or a low-pressure lavage, respectively. There was no difference in the success rate between both arms (80.9 vs. 86.5%, p = 0.56).

CONCLUSION:

The use of a high-pressure pulsatile lavage during open débridement of implant infections had a similar success rate as a low-pressure lavage.

PMID:
21387137
DOI:
10.1007/s00402-011-1291-8
[Indexed for MEDLINE]

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