Local antibacterial therapy in periprosthetic knee infection

Introduction: treatment of periprosthetic joint infection (PJI) with functioning sinus tract is characterized by a high failure rate. Local antimicrobial therapy could be considered as a possible perspective method to improve the rates of infection eradication in this category of patients.

Materials and methods: the study included 46 patients with a fistulous form of knee PJI who were admitted for two-stage reimplantation to the clinic of the Vreden National Medical Research Centre for Traumatology and Orthopedics for the period 2014-2018 (retrospective group, n=30) and 2020-2022 (prospective group, n=16). The following parameters were analyzed: basic laboratory tests, microbiology findings, intraoperative parameters, the effectiveness of infection eradication at the stages of treatment.

Results: there was no significant difference in laboratory parameters and the pathogen structure in comparison groups. Attention is drawn to the significantly shorter operation time, the volume of blood loss and blood loss speed in the prospective group of patients. Eradication of infection after the first stage was achieved in 87,5% of patients of the prospective group and in 76,7% of patients of the retrospective group. The effectiveness of the second stage in the prospective group was 92,7%, in the retrospective group – 78.3%. As a result, the overall effectiveness of two-stage treatment in patients of the prospective group was significantly higher (p < 0,05) than in patients of the comparison group: 81,2% and 64,3%, respectively.

Conclusions: The proposed method of local antibacterial therapy allowed to increase the effectiveness of two-stage treatment of the fistulous form of PJI by reducing the proportion of recurrent infections from 35,7% in the retrospective group to 18,8% in the prospective cohort. Obtained result allows us to recommend the proposed regimen for wider clinical use, however, prospective randomized controlled trials are necessary to recommend it as a routine treatment algorithm.

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