Suction-Powered Intramedullary Bone Debridement Technology Compared to Conventional Curettage in Infected Revision Total Knee Arthroplasty

Abstract

Background

Revision total knee arthroplasty (TKA) in the United States is an increasingly common procedure, often performed in the setting of prosthetic joint infection. Debridement of the intramedullary canals is traditionally performed with surgical curettes and is technically difficult and time-intensive. A suction-powered bone harvester (SPBH) is designed to improve the quality of debridement in a closed-capture system. This study assesses conventional curettage (CC) versus SPBH in debridement mass and time from intramedullary spaces. We hypothesize that SPBH will increase debridement yield more efficiently than conventional curettes.

Methods

Adult patients undergoing revision TKA were enrolled to participate in the study and were divided into 2 groups. Patients in group 1 received tibial debridement with CC followed by SPBH and femoral canals with SPBH alone. Patients in group 2 received femoral debridement with CC followed by SPBH and tibial canals with SPBH alone.

Results

Data were collected from 30 revision TKA cases in the setting of prosthetic joint infection. In total, 14 femora and 16 tibiae were initially debrided with SPBH, while the opposites were debrided with CC. On average, the intramedullary debridement with SPBH yielded 23.1 g compared to 13.2 g with CC (P = .0017). The intramedullary canal required 1 minute 28 seconds for debridement with SPBH compared to 2 minutes for debridement with CC (P = .0347). Culture data from samples obtained from SPBH were noninferior to CC.

Conclusions

SPBH is an effective tool for debridement of intramedullary canal during revision TKA. SPBH led to a significant increase of debrided mass in significantly less time than CC. There was no difference in positive culture yield between the 2 debridement techniques. This debridement technique merits consideration to reduce bioburden in revision TKA.