Eradication rates, risk factors, and implant selection in two-stage revision knee arthroplasty: a mid-term follow-up study

Abstract

BackgroundTwo-stage revision (TSR) knee arthroplasty is an established treatment, but failure to control infection still occurs in 4–50 % of cases. The aim of this study was to assess the infection eradication rate, risk factors for failure, and the clinical outcome after two-stage revision knee arthroplasty.MethodsThis retrospective study included 59 patients who had undergone at least one two-stage revision procedure due to periprosthetic joint infection (PJI). Demographic data, comorbidities, types of implant, and complications were analyzed. Univariate and multivariate logistic regression analysis were used to identify risk factors for failure.ResultsThe infections were controlled in 55 patients (93.2 %). The follow-up period was 4.1 (±2.7) years. Infection control was achieved after the first TSR in 42 patients (71.2 %) and after the second TSR in 13 (76.5 %). The percentage of arthrodesis procedures in patients with infection control increased from 16.75 % after one TSR to 69.2 % after two TSRs. Multivariate logistic regression analysis identified body mass index (BMI) (odds ratio 1.22; 95 % confidence intervals, 1.07 to 1.40; p = 0.004) and smoking (OR 21.52; 95 % CI, 2.60 to 178.19; p = 0.004) as risk factors for failure.ConclusionsTwo-stage revision protocols can achieve acceptable results even after a second procedure. It is still unclear whether the choice of implant influences failure rates. Risk factors for failure after two-stage revision were identified. Studies with larger sample sizes are needed in order to support these findings and identify further risk factors. To reduce failure rates, programs should be established to treat or minimize risk factors in patients with PJI.

Predictors of Treatment Failure for Hip and Knee Prosthetic Joint Infections in the Setting of 1- and 2-Stage Exchange Arthroplasty: A Multicenter Retrospective Cohort

“…The presence of a sinus tract and liver disease were patient characteristics associated with treatment failure, which have been demonstrated previously [10, 27]. Sinus tracts are often indicative of long-standing infection, which may make biofilm eradication challenging and further perturb bone stalk.…”

Serum biomarkers in periprosthetic joint infections

“…Two-stage revision arthroplasty of infected prosthetic joints is commonly performed in North America as definitive treatment of PJI. 45 , 46 Determining whether a patient who has undergone the first stage of a staged revision arthroplasty is ready for reimplantation is a diagnostic dilemma. These patients have recently undergone explantation, typically in the six to eight weeks prior, which affects nonspecific inflammatory markers such as ESR and CRP.…”

One‐Stage Arthroplasty or Revision for Seronegative Infections in Hip and Knee

“…The current gold standard for the treatment of chronic PJI is the two-stage revision, removing the original prosthesis and implanting the antibiotic cement spacer after thorough debridement; 4-6 weeks intravenous and 4-6 weeks oral antibiotic treatment follows, and a new prosthesis is implanted after the infection is controlled 3,16 . Drexler et al treated patients with chronic PJI with two-stage revision after TKA; the success rate of the two-stage revision surgery was up to 85.4% 17 .…”

“…treated patients with chronic PJI with two‐stage revision after TKA; the success rate of the two‐stage revision surgery was up to 85.4%. Hoell's study found that the two‐stage revision for chronic PJI of TKA had a success rate of 93.2% for 4 years of follow up. The two‐stage revision has a high success rate for TJI.…”