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First experiences with negative pressure wound therapy and instillation in the treatment of infected orthopaedic implants: a clinical observational study

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Abstract

Purpose

Infections associated with orthopaedic implants remain a serious complication. The main objective in acute infection control is component retention, whereas this option is usually not considered for chronic infections.

Methods

This multi-centre prospective, non-randomised observational study investigated one possible treatment option for implant retention in combination with negative pressure wound therapy with instillation (NPWTi). Thirty-two patients with an infected orthopaedic implant were analysed. Twenty-two patients had an acute infection (< 8 weeks after implantation) and ten patients had a chronic infection (> 8 weeks and < 36 weeks after implant placement). Polyhexanide was used as the instillation solution in 31 of the 32 cases.

Results

Nineteen patients (86.4%) with an acute infection and eight patients (80%) with a chronic infection retained their implant at 4–6 months follow-up after treatment.

Conclusions

Our study showed that NPWTi can be used as adjunctive therapy for salvage of acutely infected orthopaedic implants and may even be considered for early chronically infected implants.

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Acknowledgements

This observational study was supported by Kinetic Concepts, Inc. (San Antonio, TX, USA). The setup of the study and evaluation of the data were performed by the individual members of the Steering Committee.

We would like to thank the following hospitals and their local investigators who have contributed data to this study: Willy Izbikci, M.D., Evangelisches Krankenhaus Muelheim a.d. Ruhr, Germany; Martin Fischer, M.D., Evangelisches Krankenhaus, Muelheim a.d. Ruhr, Germany; Louk van Doorn, Leiderdorp Hospital, Leiderdorp, The Netherlands; Markus Schmoeger, M.D., Rhoen-Saale Klinik, Bad Neustadt, Germany; Wolfgang Huber, M.D., Zollernalb Klinikum, Balingen, Germany; Emese Scholl, M.D., Zollernalb Klinikum, Balingen, Germany; Rhidian Morgan-Jones, M.D., University Hospital Cardiff, Cardiff, UK; Paul Zirker, University Hospital Cardiff, Cardiff, UK; Kay Schendel, M.D., University Hospital Halle-Wittenberg, Halle a.d. Saale, Germany.

We also thank Herman Chavarria, M.S. and David Flores for their statistical analyses and Laura McMorris, Ph.D. for her editorial assistance.

Conflict of interest

Burkhard Lehner, M.D. and Gerrolt N. Jukema, M.D., Ph.D. were appointed as consultants to this observational study and are members of the study Steering Committee. Wim Fleischmann, M.D. is the patent holder of the V.A.C. Instill® system and member of the study Steering Committee.

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Correspondence to Burkhard Lehner.

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Lehner, B., Fleischmann, W., Becker, R. et al. First experiences with negative pressure wound therapy and instillation in the treatment of infected orthopaedic implants: a clinical observational study. International Orthopaedics (SICOT) 35, 1415–1420 (2011). https://doi.org/10.1007/s00264-011-1274-y

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  • DOI: https://doi.org/10.1007/s00264-011-1274-y

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