Midterm Survival of a Varus–Valgus Constrained Implant following One-Stage Revision for Periprosthetic Joint Infection: A Single-Center Study

Abstract

Revision total knee arthroplasty (TKA) is challenging to perform in patients with periprosthetic joint infection (PJI) due to the difficulty of eradicating the infection and potential for bone and ligamentous deficits. The current study aimed to evaluate the midterm survival of varus–valgus constrained (VVC) implants used in one-stage revision TKA for chronic PJI at our institution. This retrospective analysis included 132 patients with chronic PJI who underwent one-stage revision using a VVC implant. The average follow-up was 51.6 months (range: 24–85 months). Five-year survival analysis was performed to set recurrent infection and mechanical failure as the end point. Hospital for special surgery (HSS) as functional outcomes was evaluated preoperatively and at the latest follow-up. A total of 12 patients (9.1%) underwent retreatment for reinfection (nine patients) and mechanical failure (three patients). The overall 5-year revision-free survival was 82.7%, the infection-free survival was 91.1%, and the mechanical failure-free survival was 98.3%. The preoperative HSS knee score improved from 35.6 points (range: 24.3–47.7 points) preoperatively to 76.8 points (range: 57.2–87.6 points) at the latest follow-up. Complications were identified in 20 patients (15.2%) which included aseptic osteolysis in 4 cases, acceptable flexion instability in 3 cases, arthrofibrosis in 2 patients, hematomas in 2 cases, calf intermuscular venous thrombosis in 6 patients, and femoral stem tip pain in 3 cases. This is the first study to report the outcomes of one-stage revision using VVC implants for knee PJI. Improved functional outcomes and good midterm survival are demonstrated at an average follow-up of 51.6 months.

Detailed Revision Risk Analysis after Single- vs. Two-Stage Revision Total Knee Arthroplasty in Periprosthetic Joint Infection: A Retrospective Tertiary Center Analysis

“…Nevertheless, this study showed an increased overall revision rate after rotating hinge prostheses with an overall survival rate of 75% at 6 years [27]. In contrast, a retrospective study of 132 patients with single-stage rotation and CCK prostheses showed an eradication rate of 91% and an overall survival rate of 82.7% at 5 years [28]. Overall, however, it should be noted that the data available for the comparison of different implant systems in PJI treatment are still very limited.…”

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

“…After excluding duplicates, 343 studies were included, and after evaluation of the title and abstract, 21 studies were analyzed. After assessing the eligibility of the full-text articles according to the inclusion and exclusion criteria and screening the bibliography of each article to find additional relevant publications, 18 clinical studies were selected and included in this systematic review [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39]. The PRISMA flowchart with the research strategy is shown in Fig.…”

“…Eighteen clinical studies [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] were included in the final analysis (Fig. 1) [17].…”

“…The mean follow-up was 57.6 ± 31.8 months. Seventeen studies [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][34][35][36][37][38][39] reported sex data, and 43.3% were men, and 56.7% were women. The demographic data of the included studies are listed in Table 1.…”

“…All eighteen studies reported overall failure due to infection after one-stage revision [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39]. Reinfection after onestage revision occurred in 108 cases (12.2%).…”