Is there still a place for continuous closed irrigation in the management of periprosthetic total knee infection?

In recent decades, many technical improvements have been achieved in the use of prosthetic joints, and the risk of infection has been greatly reduced, to current rates of 0.4-2.0% following primary knee replacement. However, the increasing rate of joint replacements being performed means that the absolute number of such infections remains significant and poses substantial costs to healthcare systems worldwide. Accordingly, further strategies to treat and prevent total joint infections should be investigated. Infections following knee replacements can compromise the function and durability of arthroplasty. When these infections occur during the immediate postoperative period, irrigation and debridement with component retention can be attempted to salvage the implant. This is an attractive, cheap, low-morbidity treatment for periprosthetic knee infection. However, the results published regarding this procedure are uneven; some studies report the eradication of prosthetic joint infection by debridement alone in 70-90% of cases but conversely, others have reported a high failure rate for this procedure, averaging 68% (61-82%). The difference could be attributed in part to the multiplicity of variables that may influence the success of the procedure. One such is that of treatment with a continuous irrigation system, which has the theoretical advantage of enabling the administration of antimicrobial agents, as well as the drainage of debris and blood clots. The objective of this study is to elucidate the overall efficacy of irrigation and debridement with prosthesis retention in infected total knee arthroplasty and to determine whether the addition of a continuous irrigation system influences this efficacy.