Characterizing recurrent infections after one-stage revision for periprosthetic joint infection of the knee: a systematic review of the literature

Bosco, Francesco; Cacciola, Giorgio; Giustra, Fortunato; Risitano, Salvatore; Capella, Marcello; Vezza, Daniele; Barberis, L; Cavaliere, Pietro; Massè, Alessandro; Sabatini, Luigi

doi:10.1007/s00590-023-03480-7

Cited by 16 publications

(9 citation statements)

References 55 publications

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“…Bone graft: All studies reported data about the prevalence and type of bone graft used in hip revision surgery ( 19 , 25 - 43 ). Bone graft was frequently used in association with TT cups in revision for acetabular bone defects.…”

Section: Resultsmentioning

confidence: 99%

Trabecular titanium cups in hip revision surgery: a systematic review of the literature

Cacciola,

Giustra,

Bosco

et al. 2023

Ann Joint

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Background Hip revision surgery in extensive acetabular bone defects represents a complex challenge for hip surgeons. The primary goal is to obtain a stable acetabular component and restore the hip biomechanics. Through the years, different prosthetic implants have been developed to perform acetabular revision depending on bone loss location and extension. This systematic review aims to summarize the clinical outcomes and complications reported with trabecular titanium (TT) cups in hip revision surgery. Methods A literature search of four databases (PubMed, Embase, Scopus and the Cochrane Database of systematic reviews) was performed according to the PRISMA guideline from January 2008 to December 2022. All studies written in English and reporting the clinical outcome of patients undergoing revision total hip arthroplasty using Delta TT cups were included. The initial screening identified 378 studies. Each eligible clinical article was analyzed according to the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence (LoE), and the papers’ methodological quality was evaluated using The Methodological Index for Non-Randomized Studies Criteria (MINORS) score. Results Eight clinical studies were included in the analysis. A total of 523 hip revisions were analyzed. Delta TT cups were used in 3.9%, Delta TT one cups in 46.8%, and Delta TT revisions in 49.3%. Paprosky IIIa was the most frequent acetabular bone defect reported in 26.4% of cases. The overall survival rate of TT cups was 93.4%. The dislocation was the most frequent complication in 4.1% of patients, while the prevalence of aseptic loosening was 1.5% Conclusions Managing severe acetabular bone defects remains a complex challenge for hip surgeons. Since their introduction, TT cups have exhibited good clinical results, with complication rates in line with or lower than those reported by similar implants.

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Section: Resultsmentioning

confidence: 99%

Trabecular titanium cups in hip revision surgery: a systematic review of the literature

Cacciola,

Giustra,

Bosco

et al. 2023

Ann Joint

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“…Thus, analysis of causative microorganisms after reinfection is also necessary. In a systematic review of recurrent infections after 1-stage revision, the causative microorganisms differed significantly from those in the primary infections, with the incidence of gram-positive bacteria found to be 71.1% during the revision surgery but 44.4% during subsequent reinfection 34 . Furthermore, another study on 113 two-stage revision TKAs found that infection recurred in 23 cases.…”

Section: Discussionmentioning

confidence: 98%

Risk of Infection After Septic and Aseptic Revision Total Knee Arthroplasty

Lee,

Kim,

Park

et al. 2023

Journal of Bone and Joint Surgery

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Background: The causes of primary total knee arthroplasty (TKA) failure can be divided into septic and aseptic etiologies. It is unclear whether the etiology affects the infection rate after revision TKA. This systematic review was conducted to evaluate whether there is a difference in infection rates between septic and aseptic revision TKA. We hypothesized that infection rates would be higher after septic revision TKA. Methods: The PubMed and Embase databases and the Cochrane Library were searched to find studies evaluating infection rates following septic and aseptic revision TKA. We included studies that compared the postoperative infection rates of a group that received revision TKA for aseptic failure and a group that received 1- or 2-stage revision TKA for septic failure. Studies on re-revision TKA and on revision surgery after partial knee arthroplasty were excluded, as were studies of debridement, antibiotics, and implant retention (DAIR). Results: Twelve studies were included in this systematic review. In studies in which 1- or 2-stage revision TKA was performed for septic failure, septic revision TKA had a significantly higher infection rate than aseptic revision TKA (odds ratio [OR], 6.83; 95% confidence interval [CI], 1.54 to 30.33; p = 0.01). Similarly, in studies in which 2-stage revision TKA was performed for septic failure, septic revision TKA had a significantly higher infection rate than aseptic revision TKA (OR, 4.14; 95% CI, 2.33 to 7.36; p < 0.00001). In the comparison of revision TKA for aseptic loosening and septic revision TKA, septic revision TKA had a higher infection rate than aseptic revision TKA (OR, 4.45; 95% CI, 2.28 to 8.70; p < 0.0001). Conclusions: Overall, septic revision TKA had a higher infection rate than aseptic revision TKA. Even when 2-stage revision TKA was performed for septic failure, the infection rate was higher after septic revision TKA than after aseptic revision. Surgeons should explain the relatively high infection rates to patients undergoing revision TKA for septic failure of their primary joint replacement. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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“…The Methodological Index for Non-Randomized Studies (MINORS) criteria score ( 35 - 37 ) was used to assess the quality of the included studies. The MINORS criteria score helps assess the relevance of non-randomized surgical research and have been frequently used in the literature regarding systematic reviews on hip and knee studies ( 38 - 40 ).…”

Section: Methodsmentioning

confidence: 99%

Outcomes of modular stem for the treatment of periprosthetic femoral fracture: a systematic review of the literature

Cacciola,

Braconi,

Bosco

et al. 2023

Ann Joint

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Background Periprosthetic femoral fractures (PFFs) are a frequent complication after total hip arthroplasty (THA). Both modular and non-modular tapered fluted titanium (TFT) stems could be used in total hip revisions (THRs). Nevertheless, the most appropriate femoral stem type is still under debate. The current systematic review aims to analyze the survival rate and all causes of stem revision, the overall complication rate and reason for reoperation, and patient reported outcome measures (PROMs) in THR for PFF using the modular tapered titanium stems (MTTS). Methods A comprehensive search in four databases, PubMed, Scopus, Embase, and the Cochrane Database of Systematic Reviews databases, was performed, and following the PRISMA guidelines, a systematic review was conducted. Strict inclusion and exclusion criteria were applied, starting from 1,259 studies. The risk of bias was analyzed according to the MINORS tool system. Descriptive statistical analysis was performed for all data extracted. Results Eighteen clinical studies were included in the qualitative analysis for a total of 775 patients enrolled. A mean MINORS criteria score of 9.8 [8–12] was reported. The overall survival of MTTS for PFF treatment was 95.4%, with an overall reintervention rate of 10.3% at an average follow-up of 4.5 years. Despite the use of modular components, postoperative hip instability remains the most frequent complication and cause of reintervention in these patients. In addition, a mean postoperative Harris Hip Score (HHS) of 78.1 was reported, which was considered acceptable given the high mean age of 74.1 years at the time of the revision. Conclusions Several therapeutic approaches and a wide variety of implants have been described in the literature for PFF management; however, no one solution has proven superior to others in the PFF treatment. MTTS has become a commonly used treatment option for Vancouver B2 and B3 fractures because they provide good clinical and radiological results with a reasonable survival rate. However, the complication rate of MTTS is still high.

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Characterizing recurrent infections after one-stage revision for periprosthetic joint infection of the knee: a systematic review of the literature

Cited by 16 publications

References 55 publications

Trabecular titanium cups in hip revision surgery: a systematic review of the literature

Trabecular titanium cups in hip revision surgery: a systematic review of the literature

Risk of Infection After Septic and Aseptic Revision Total Knee Arthroplasty

Outcomes of modular stem for the treatment of periprosthetic femoral fracture: a systematic review of the literature

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