Application of the New Irrigation Protocol to Reduce Recurrence Rate in the Management Of Periprosthetic Joint Infection
Objective Irrigation is a conventional treatment for acute and chronic periprosthetic joint infections (PJI). However, there has been no unified standard for irrigation during surgery for PJI in the past, and the efficacy is uncertain. The purpose of this study is to create a new irrigation protocol...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2024-03-01
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| Series: | Orthopaedic Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1111/os.13948 |
| _version_ | 1797266527323422720 |
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| author | Xiaoyu Wu Weishen Chen Rong Rong Baiqi Pan Xuantao Hu Linli Zheng Aerman Alimu Chenghan Chu Yucheng Tu Ziji Zhang Yongyu Ye Minghui Gu Puyi Sheng |
| author_facet | Xiaoyu Wu Weishen Chen Rong Rong Baiqi Pan Xuantao Hu Linli Zheng Aerman Alimu Chenghan Chu Yucheng Tu Ziji Zhang Yongyu Ye Minghui Gu Puyi Sheng |
| author_sort | Xiaoyu Wu |
| collection | DOAJ |
| description | Objective Irrigation is a conventional treatment for acute and chronic periprosthetic joint infections (PJI). However, there has been no unified standard for irrigation during surgery for PJI in the past, and the efficacy is uncertain. The purpose of this study is to create a new irrigation protocol to enhance the infection control rate and reduce the postoperative recurrence rate of PJI patients. Methods We conducted a single‐institution retrospective review with a total of 56 patients who underwent revision total hip or knee arthroplasties due to PJI from January 2011 to January 2022. Conventional irrigation (CI) was used in 32 cases, and standard operating procedure of irrigation (SOPI) was used in 24. The CI protocol carries out an empirical irrigation after debridement, which is quite random. Our SOPI protocol clearly stipulates the soaking concentration and time of hydrogen peroxide and povidone‐iodine. The irrigation is carried out three times, and tissue samples are taken from multiple parts before and after irrigation, which are sent for microbial culture. The important statistical indicators were the rate of positive microbiological culture and postoperative recurrence rate with an average follow‐up of 24 average months. Results The drainage volume was lower in the SOPI group than in the CI group on postoperative day 3 (p < 0.01) and 7 (p = 0.016). In addition, the percentage of positive microbiological cultures after the third irrigation was less than that before (p < 0.01) and after (p < 0.01) the first irrigation. The most common causative organism was Staphylococcus aureus, which was detected in 25.0% and 12.5% of the SOPI and CI groups, respectively. The failure rate at the final follow‐up was 8.3% and 31.3% (p = 0.039) for the SOPI and CI groups, respectively. Conclusion Compared with the traditional CI method, SOPI standardized the soaking time of hydrogen peroxide and povidone‐iodine, increased the frequency of and irrigation, and proved that microorganisms were almost completely removed through the microbial culture of multiple tissues. SOPI has the potential to become a standardized irrigation process worthy of promotion, effectively reducing the postoperative recurrence rate of PJI patients. |
| first_indexed | 2024-04-25T01:02:06Z |
| format | Article |
| id | doaj.art-dd912458801646fdb0e496b217bf11f0 |
| institution | Directory Open Access Journal |
| issn | 1757-7853 1757-7861 |
| language | English |
| last_indexed | 2024-04-25T01:02:06Z |
| publishDate | 2024-03-01 |
| publisher | Wiley |
| record_format | Article |
| series | Orthopaedic Surgery |
| spelling | doaj.art-dd912458801646fdb0e496b217bf11f02024-03-11T02:14:06ZengWileyOrthopaedic Surgery1757-78531757-78612024-03-0116357758410.1111/os.13948Application of the New Irrigation Protocol to Reduce Recurrence Rate in the Management Of Periprosthetic Joint InfectionXiaoyu Wu0Weishen Chen1Rong Rong2Baiqi Pan3Xuantao Hu4Linli Zheng5Aerman Alimu6Chenghan Chu7Yucheng Tu8Ziji Zhang9Yongyu Ye10Minghui Gu11Puyi Sheng12Department of Joint Surgery The First Affiliated Hospital of Sun Yat‐Sen University Guangzhou ChinaDepartment of Joint Surgery The First Affiliated Hospital of Sun Yat‐Sen University Guangzhou ChinaDepartment of Nosocomial Infection The First Affiliated Hospital of Sun Yat‐Sen University Guangzhou ChinaDepartment of Joint Surgery The First Affiliated Hospital of Sun Yat‐Sen University Guangzhou ChinaDepartment of Joint Surgery The First Affiliated Hospital of Sun Yat‐Sen University Guangzhou ChinaDepartment of Joint Surgery The First Affiliated Hospital of Sun Yat‐Sen University Guangzhou ChinaDepartment of Joint Surgery The First Affiliated Hospital of Sun Yat‐Sen University Guangzhou ChinaDepartment of Joint Surgery The First Affiliated Hospital of Sun Yat‐Sen University Guangzhou ChinaDepartment of Joint Surgery The First Affiliated Hospital of Sun Yat‐Sen University Guangzhou ChinaDepartment of Joint Surgery The First Affiliated Hospital of Sun Yat‐Sen University Guangzhou ChinaDepartment of Spinal Surgery Guangdong Provincial People's Hospital Guangzhou ChinaDepartment of Joint Surgery The First Affiliated Hospital of Sun Yat‐Sen University Guangzhou ChinaDepartment of Joint Surgery The First Affiliated Hospital of Sun Yat‐Sen University Guangzhou ChinaObjective Irrigation is a conventional treatment for acute and chronic periprosthetic joint infections (PJI). However, there has been no unified standard for irrigation during surgery for PJI in the past, and the efficacy is uncertain. The purpose of this study is to create a new irrigation protocol to enhance the infection control rate and reduce the postoperative recurrence rate of PJI patients. Methods We conducted a single‐institution retrospective review with a total of 56 patients who underwent revision total hip or knee arthroplasties due to PJI from January 2011 to January 2022. Conventional irrigation (CI) was used in 32 cases, and standard operating procedure of irrigation (SOPI) was used in 24. The CI protocol carries out an empirical irrigation after debridement, which is quite random. Our SOPI protocol clearly stipulates the soaking concentration and time of hydrogen peroxide and povidone‐iodine. The irrigation is carried out three times, and tissue samples are taken from multiple parts before and after irrigation, which are sent for microbial culture. The important statistical indicators were the rate of positive microbiological culture and postoperative recurrence rate with an average follow‐up of 24 average months. Results The drainage volume was lower in the SOPI group than in the CI group on postoperative day 3 (p < 0.01) and 7 (p = 0.016). In addition, the percentage of positive microbiological cultures after the third irrigation was less than that before (p < 0.01) and after (p < 0.01) the first irrigation. The most common causative organism was Staphylococcus aureus, which was detected in 25.0% and 12.5% of the SOPI and CI groups, respectively. The failure rate at the final follow‐up was 8.3% and 31.3% (p = 0.039) for the SOPI and CI groups, respectively. Conclusion Compared with the traditional CI method, SOPI standardized the soaking time of hydrogen peroxide and povidone‐iodine, increased the frequency of and irrigation, and proved that microorganisms were almost completely removed through the microbial culture of multiple tissues. SOPI has the potential to become a standardized irrigation process worthy of promotion, effectively reducing the postoperative recurrence rate of PJI patients.https://doi.org/10.1111/os.13948Irrigation protocolPeriprosthetic joint infectionRecurrenceRevisionStaphylococcus aureus |
| spellingShingle | Xiaoyu Wu Weishen Chen Rong Rong Baiqi Pan Xuantao Hu Linli Zheng Aerman Alimu Chenghan Chu Yucheng Tu Ziji Zhang Yongyu Ye Minghui Gu Puyi Sheng Application of the New Irrigation Protocol to Reduce Recurrence Rate in the Management Of Periprosthetic Joint Infection Orthopaedic Surgery Irrigation protocol Periprosthetic joint infection Recurrence Revision Staphylococcus aureus |
| title | Application of the New Irrigation Protocol to Reduce Recurrence Rate in the Management Of Periprosthetic Joint Infection |
| title_full | Application of the New Irrigation Protocol to Reduce Recurrence Rate in the Management Of Periprosthetic Joint Infection |
| title_fullStr | Application of the New Irrigation Protocol to Reduce Recurrence Rate in the Management Of Periprosthetic Joint Infection |
| title_full_unstemmed | Application of the New Irrigation Protocol to Reduce Recurrence Rate in the Management Of Periprosthetic Joint Infection |
| title_short | Application of the New Irrigation Protocol to Reduce Recurrence Rate in the Management Of Periprosthetic Joint Infection |
| title_sort | application of the new irrigation protocol to reduce recurrence rate in the management of periprosthetic joint infection |
| topic | Irrigation protocol Periprosthetic joint infection Recurrence Revision Staphylococcus aureus |
| url | https://doi.org/10.1111/os.13948 |
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