Key concept
Irrigation and debridement with polyethylene insert exchange (IDPE) or Open debridement and polyethylene insert exchange (ODPE) is a form of DAIR (Debridement, Antibiotics and Implant Retention) used for selected acute periprosthetic joint infections (PJI) after TKA.
When to consider and when not to consider IDPE or ODPE?
| Favorable | Unfavorable |
| Acute PJI, duration ideally ≤2 weeks | Chronic/Late PJI |
| No sinus tract | Sinus tract |
| Mechanically stable components | Component loosening |
| Wound can be adequately closed | Wound cannot be closed adequately |
| Appropriate antimicrobial therapy can be administered | Highly virulent organisms like MRSA, MRSE, Pseudomonas |
| Frail or elderly patients | Significant patient/systemic risk factors |
Timing is critical: success decreases substantially as symptom duration increases.
Tibial insert exchange and single-stage revision may be acceptable in frail or elderly patients who may not tolerate the morbidity of two-stage revision, despite the higher risk of revision for repeat infection.
Evidence for timing
| Timing / selection | Reported success |
|---|---|
| Within 2 weeks | 82% |
| >2 weeks | 50% |
| Very early intervention (≤5 days) | 88% |
Possible adjuncts
Reported adjunctive strategies to improve infection control after IDPE/ODPE include:
- Povidone iodine lavage + Vancomycin powder (Riesgo et.al.): After final polyethylene insertion –
- Step 1: 0.35% dilute povidone iodine lavage
- Step 2: 1 litre NS lavage
- Step 3:1 gram vancomycin instillation
- Antibiotic beads (Estes et.al.): 2 stage debridement
- Debridement and Implant retention + Antibiotic beads in 1st stage
- Beads removal and Polyethylene exchange within 2 days as 2nd stage
- Only 12.5% re-revision required at a minimum follow-up of 1.2 years
Reference: Moses AM, Cushing ME, Fawcett MA, Dohse N, Adigweme OO, Ledford CK. Isolated Polyethylene Exchange in Revision Total Knee Arthroplasty: A Review of Indications and Outcomes. J Clin Med. 2025 Sep 25;14(19):6779. doi: 10.3390/jcm14196779. PMID: 41095857; PMCID: PMC12524850.
He is the section editor of Orthopedics in Epomedicine. He searches for and share simpler ways to make complicated medical topics simple. He also loves writing poetry, listening and playing music. He is currently pursuing Fellowship in Hip, Pelvi-acetabulum and Arthroplasty at B&B Hospital.
