The effect of post-operative continuous negative pressure therapy after debridement, antibiotics, and implant retention for acute periprosthetic joint infection.

BACKGROUND

Acute periprosthetic joint infection (PJI) is a serious complication after total knee and hip replacement, with varying success rates in its management using debridement, antibiotics, and implant retention (DAIR). We hypothesize that the application of post-operative continuous negative pressure therapy (CNPT) can improve the success rate of DAIR in the treatment of acute knee and hip PJI.

METHODS

In this retrospective study from October 2018 to December 2022, 62 patients diagnosed with acute PJI were divided into two groups: 24 patients treated with DAIR and CNPT, and 38 patients treated with DAIR alone. The groups were comparable in terms of patient characteristics, organism profile, and clinical findings. The primary outcome was treatment failure based on the Delphi consensus criteria for 1-year follow up. The statistical analysis involved univariate and multivariate regression.

RESULTS

After a year of follow-up, the CNPT group had a significantly lower treatment failure rate (25%) compared to the control group (55.3%, p = 0.019). After controlling the confounding factors, the use of CNPT remained as a significant factor with a lower OR (adjusted OR: 0.13; 95% CI 0.02-0.86, p = 0.034), indicating its potential effectiveness in improving DAIR outcomes.

CONCLUSION

The study suggests that CNPT could substantially enhance the success rate of DAIR in treating acute PJI. This intervention may represent a significant advancement in post-operative care, potentially reducing the failure rate of DAIR treatment and improving patient outcomes.