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J Knee Surg 2022; 35(08): 874-883
DOI: 10.1055/s-0040-1721087
Original Article

Clorpactin: An Alternative Irrigation Method for Total Knee Arthroplasty Joint Infection Revisions

Keith Kotecki
1   Valley Hospital Orthopedic Surgery Residency Program, Valley Hospital Medical Center, Las Vegas, Nevada
,
Michael S. Bradford
1   Valley Hospital Orthopedic Surgery Residency Program, Valley Hospital Medical Center, Las Vegas, Nevada
2   Department of Orthopedic Surgery, Nevada Orthopedic and Spine Center, Las Vegas, Nevada
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Abstract

Different combinations of irrigation solutions have been used in attempt to eradicate microorganisms for the prevention and treatment of prosthetic joint infections (PJIs). Clorpactin WCS-90 was evaluated as an alternative irrigation intraoperative technique for the treatment of PJI using both debridement, antibiotics, and implant retention (DAIR) and 2-stage total knee arthroplasty (TKA) procedures. We retrospectively reviewed PJIs irrigated with Clorpactin between January 2015 and January 2020. We found 13 patients who underwent a DAIR procedure for an acutely infected primary TKA, 18 patients underwent a 2-stage procedure for a chronically infected primary TKA, two patients underwent a DAIR procedure for an acutely infected revision TKA, and 18 patients underwent a 2-stage procedure for a chronically infected revision TKA. The odds of reinfection and need for additional surgery were analyzed at a mean follow-up of 20 to 26 months between groups. Only one patient (7.69%) became reinfected in the acute infected primary TKA group, three patients (16.67%) in the chronic infected primary TKA group, 0 patients (0%) in the acute infected revision TKA group, and six patients (33.33%) in the chronic infected revision TKA group. When the acute primary TKA infection group was compared with the chronic revision TKA infection group, the odds of reinfection (Chi-square test [χ2] = 21.7, df 3, p < 0.001) and odds of additional surgery (χ2 = 13.6, df 3, p < 0.003) were significantly higher for the chronic revision TKA infection group. Overall, the reinfection rate for DAIR revisions was 6.67% (range = 0–7.69) and 2-stage revisions was 25.00% (range = 16.67–33.33). The use of Clorpactin WCS-90 irrigation prior to wound closure is a useful option for the treatment of acute and chronic knee PJIs. Our study provides evidence that infection eradication with the use of Clorpactin is comparable to other irrigation methods and surgical techniques in reported literature.

Keywords

prosthetic joint infection - Clorpactin - sodium oxychlorosene - irrigation - total knee arthroplasty

Note

This study was reviewed and deemed exempt by the Touro University of Nevada Institutional Review Board located in Las Vegas, Nevada.




Publication History

Received: 29 April 2020

Accepted: 05 October 2020

Article published online:
23 November 2020

© 2020. Thieme. All rights reserved.

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