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      Efficacy of Taurolidine Irrigation in Primary Total Knee Arthroplasty

      research-article
      Author(s): , MD, , MD , , MD, , MD
      Publication date (Electronic):
      Journal: Knee Surgery & Related Research
      Publisher: Korean Knee Society
      Keywords: Knee, Infection, Arthroplasty, Taurolidine, C-reactive protein

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          Abstract

          Purpose

          Taurolidine is an antimicrobial agent that was originally used in the local treatment of peritonitis. The aim of this study was to evaluate the efficacy of taurolidine irrigation in primary total knee arthroplasty (TKA).

          Materials and Methods

          All patients who underwent TKA at our institute from January 2015 to March 2017 were eligible. There were 300 patients in the taurolidine irrigation group and 300 patients in the control group. The patients in the taurolidine irrigation group were irrigated after implantation with a mix of 250 mL of taurolidine and 750 mL of normal saline. The patients in the control group were not irrigated after implantation. We compared postoperative C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and infection rate between groups.

          Results

          The taurolidine irrigation group had a significantly lower CRP (5.39 mg/dL vs. 7.55 mg/dL; p<0.001) and ESR (53.21 mm/hr vs. 58.74 mm/hr; p=0.003) on postoperative day 3 after TKA, as compared with the control group. However, there was no difference between the two groups on postoperative days 6, 13, and 20. Periprosthetic joint infection occurred in one patient in the taurolidine irrigation group.

          Conclusions

          We believe that it is not necessary to use taurolidine for patients who undergo primary TKA.

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          Most cited references25

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          Prosthetic joint infection risk after TKA in the Medicare population.

          Daniel Berry, S L Kurtz, Kevin J Bozic … (2009)
          The current risk of infection in contemporary total knee arthroplasty (TKA) as well as the relative importance of risk factors remains under debate as a result of the rarity of the complication and temporal changes in the treatment and prevention of infection. We therefore determined infection incidence and risk factors after TKA in the Medicare population. The Medicare 5% national sample administrative data set was used to identify and longitudinally follow patients undergoing TKA for deep infections and revision surgery between 1997 and 2006. Cox regression was used to evaluate patient and hospital characteristics. In 69,663 patients undergoing elective TKA, 1400 TKA infections were identified. Infection incidence within 2 years was 1.55%. The incidence between 2 and up to 10 years was 0.46%. Women had a lower risk of infection than men. Comorbidities also increased TKA infection risk. Patients receiving public assistance for Medicare premiums were at increased risk for periprosthetic joint infection (PJI). Hospital factors did not predict an increased risk of infection. PJI occurs at a relatively high rate in Medicare patients with the greatest risk of PJI within the first 2 years after surgery; however, approximately one-fourth of all PJIs occur after 2 years. Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
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            Diagnosis of periprosthetic joint infections of the hip and knee.

            Jonathan Keith, William Watters, P DiCesare … (2010)
            No preferred test for diagnosis of periprosthetic joint infection exists, and the algorithm for the workup of patients suspected of infection remains unclear. The work group evaluated the available literature to determine the role of each diagnostic modality and devise a practical algorithm that allows physicians to reach diagnosis of periprosthetic joint infection. Ten of the 15 recommendations have strong or moderate evidence in support. These include matters involving erythrocyte sedimentation rate and C-reactive protein level testing, knee and hip aspiration, and stopping the use of antibiotics prior to obtaining intra-articular cultures. The group recommends against the use of intraoperative Gram stain but does recommend the use of frozen sections of peri-implant tissues in reoperation patients in whom infection has not been established, as well as multiple cultures in reoperation patients being assessed for infection. The group recommends against initiating antibiotic treatment in patients with suspected infection until after joint cultures have been obtained, but recommends that prophylactic preoperative antibiotics not be withheld in patients at lower probability for infection.
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              C-reactive protein (CRP) levels after elective orthopedic surgery.

              U Thelander, S Larsson, S Friberg (1992)
              The levels of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were determined by serial measurements after four types of uncomplicated elective orthopedic surgery. The type of operations chosen for this study were total hip arthroplasty (primary, n = 109; and revisions caused by aseptic loosening, n = 9), unicondylar knee arthroplasty (n = 39), and lumbar microdiskectomy (n = 36). In all patients, CRP levels increased after surgery, reaching peak levels on the third day after hip arthroplasties (primary, 116 +/- 43 mg/l; revisions, 136 +/- 58 mg/l) and on the second day after knee arthroplasties (140 +/- 46 mg/l) and lumbar microdiskectomy (48 +/- 27 mg/l). C-reactive protein levels usually dropped to normal (less than 10 mg/l) within 21 days after surgery. No correlations were found between CRP response and the type of anesthesia, amount of bleeding, transfusion, operation time, administered drugs, age, or gender. Erythrocyte sedimentation rate increased to peak levels about five days after surgery, followed by a slow and irregular decrease. Still, 42 days after uncomplicated operations ESR often remained elevated. In conclusion, the level of CRP must be considered a better diagnostic aid for the early detection of postoperative infections than ESR. It can be assumed that the rapid decline in CRP after uncomplicated orthopedic surgery will be interrupted by a second rise or by a persisting elevated level if infectious complications occur.
              Article 0 comments Cited 37 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Knee Surg Relat Res
                Journal ID (iso-abbrev): Knee Surg Relat Res
                Title: Knee Surgery & Related Research
                Publisher: Korean Knee Society
                ISSN (Print): 2234-0726
                ISSN (Electronic): 2234-2451
                Publication date (Print): June 2018
                Publication date (Electronic): 01 June 2018
                Volume: 30
                Issue: 2
                Pages: 142-146
                Affiliations
                Department of Orthopedic Surgery, Busan Bumin Hospital, Busan, Korea
                Author notes
                Correspondence to: Ju Seon Jeong, MD, Department of Orthopedic Surgery, Bumin Hospital, 59 Mandeok-daero, Buk-gu, Busan 46555, Korea, Tel: +82-51-330-3082, Fax: +82-51-330-3075, E-mail: mdjjs78@ 123456naver.com
                Article
                Publisher ID: ksrr-30-142
                DOI: 10.5792/ksrr.17.054
                PMC ID: 5990238
                PubMed ID: 29554718
                SO-VID: 94b2c1c3-bbdc-4319-a455-5c6638992b3b
                Copyright © Copyright © 2018 Korean Knee Society
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 24 July 2017
                Date revision received : 08 September 2017
                Date revision received : 19 September 2017
                Date revision received : 21 September 2017
                Date revision received : 09 October 2017
                Date accepted : 30 October 2017
                Categories
                Subject: Original Article

                ScienceOpen disciplines: Surgery
                Keywords: knee,infection,arthroplasty,taurolidine,c-reactive protein
                Data availability:
                ScienceOpen disciplines: Surgery
                Keywords: knee, infection, arthroplasty, taurolidine, c-reactive protein

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