Treatment of the infected total knee replacement combining DAIR with continuous local antibiotic perfusion: a preliminary case report series.

BACKGROUND

Continuous local antibiotics perfusion (CLAP) involves placing a bone marrow needle and a double-lumen tube in the infected area, through which an antibiotic at an appropriate concentration is continuously administered. CLAP has shown good outcomes in patients with bone and soft tissue infections. However, the use of CLAP for late infection after total knee arthroplasty (TKA) is rarely reported. We addressed the gap in the treatment of prosthetic joint infection (PJI) using intra-joint antibiotics perfusion (iJAP) combined with debridement, antibiotics, and implant retention (DAIR) to treat patients with PJI.

METHODS

This case series study included seven patients who received iJAP combined with DAIR for the treatment of late infection. Continuous passive motion (CPM) was administered immediately after surgery. The diagnosis of late infection was based on the Musculoskeletal Infection Society criteria. Clinical outcomes including success rate and range of motion at 2 years after iJAP were investigated.

RESULTS

In all cases, the infection was eradicated with the implants retained. The success rate of the first iJAP with DAIR was 100%, and the average range of motion was 111.9° at 1 year postoperatively.

CONCLUSIONS

iJAP for late infection after primary TKA resulted in good outcomes, and the range of motion was similar to that reported in previous studies. CPM use immediately after surgery prevented short-circuiting of perfusion and contributed to a good postoperative motion. iJAP with DAIR may be a useful treatment for late infection after TKA.