A new treatment for early postoperative infections of prosthetic joint: intermittent irrigation with povidone iodine / 中华骨科杂志

ABSTRACT

Objective:To investigate the clinical effects of intermittent irrigation with povidone iodine for early postoperative infections of prosthetic joint.Methods:From September 2014 to September 2017, a total of 6 patients with early postoperative infections of prosthetic joint were analyzed retrospectively. They underwent one of three types of orthopedic surgery, namely femoral head replacement (FHR), total hip arthroplasty (THA) or total knee arthroplasty (TKA). These patients were treated with intermittent irrigation at the bedside instead of debridement. After extensive disinfection, the presence of pus and sinuses communicating with the prosthesis were detected with vascular forceps. Then, the specimens were taken for bacterial culture. Under the protection of the forceps, a needle was entered the joint cavity. Povidone iodine solution (50 g/L, 10 ml) was injected into the joint for irrigation. The intervention was repeated once every day. When the wound was fresh, no pus was observed with negative bacterial cultures for more than twice. The irrigation operation was stopped followed by dressing change until the wound heals. During the follow-up, six patients were observed for systemic and local infections, including body temperature, swelling, tenderness, fluctuations, exudation and sinus. At 1, 3, 6, 12 and 24 months after discharge, the routine blood tests, erythrocyte sedimentation rate, C-reactive protein, liver and kidney function were tested. X-rays of the affected joints were examined to record the signs of infection such as prosthesis subsidence, loosening, osteolysis, and periosteal reaction. Harris/KSS joint function score and visual analogue score (VAS) were used to evaluate the hip or knee joint function. The iatrogenic injuries and complications were also recorded.Results:The follow-up duration was 42.1±13.4 months (24-60 months). Each case has been irrigated for 12.7±5.7 times (6-18 times). At the last follow-up, all patients achieved satisfied incision healing. No swelling, exudation, systemic and local infection was observed without signs of infection such as osteolysis, loosening of prosthesis and periosteal reaction in radiographs. The VAS scores at 1, 3, 6, 12, 24 months after discharge were all lower than those at the preoperative (4.67±0.82) ( F=24.79, P<0.001). The Harris scores of the 5 hip patients at 1, 3, 6, 12, 24 months after discharge were 70.00±8.92, 76.40±7.23, 81.40±6.07, 82.80±4.87 and 83.20±5.07, respectively. No statistical difference was found between them ( P>0.05). However, they were all higher than the preoperative Harris score (22.40±12.74) ( F=43.74, P<0.001). In a patient with TKA, the knee function was significantly improved after discharge. Before surgery and 1, 3, 6, 12, 24 months after discharge, the KSS scores were 50, 75, 80, 88, 90 and 90 respectively. No iatrogenic injuries, serious complications such as deep vein thrombosis, pulmonary embolism, severe liver/kidney damage or deaths were observed. Conclusion:When debridement is contraindicated or refused by patients, intermittent irrigation with povidone iodine may be a treatment method for patients with early postoperative infections of prosthetic joint.