One-stage versus two-stage prosthesis replacement for prosthetic knee infections

Ribes, Christopher; Masquefa, T.; Dutronc, H.; Seynes, Camille de; Dupon, M.; Fabre, Thierry; Dauchy, Frédéric‐Antoine

doi:10.1016/j.medmal.2019.01.013

Cited by 7 publications

(13 citation statements)

References 26 publications

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“…Our clinical cases presented PJI without sinus tract or inadequate soft tissue coverage, no systemic manifestation of infection and with identified organisms prior to surgery; none of the usual criteria for a 2-stage exchange strategy were present [14]. More recently, a better functional outcome of 1-stage exchange strategy has been suggested in total knee arthroplasty [15,16]. Those results need to be confirmed but they highlight another crucial outcome criteria which has to be considered beside the microbiological cure.…”

Section: Surgical Managementmentioning

confidence: 71%

Management of prosthetic joint infections in France: a national audit to identify key situations requiring innovation and homogenization

et al. 2021

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Background Prosthetic joint infections (PJI) are one of the most serious complication of arthroplasty. The management of PJI needs a multidisciplinary collaboration between orthopaedic surgeon, infectious disease specialist and microbiologist. In France, the management of PJI is organized around reference centres (CRIOACs). Our main objective was to perform an audit through a questionnaire survey based on clinical cases, to evaluate how French physicians manage PJI. Eligible participants were all physicians involved in care of patients presenting a PJI. Physicians could answer individually, or collectively during a multidisciplinary team meeting dedicated to PJI. The survey consisted as three questionnaires organized in a total of six clinical cases. Results Answers from the CRIOACs to the three questionnaires were 92, 77, and 53%. Between 32 and 39% of respondents did not administer antibiotic prophylaxis despite positive S. aureus pre-operative documentation. One-stage exchange strategy was widely preferred in all clinical cases, with no difference between CRIOACs and other centres. Rifampicin was prescribed for S. aureus PJI, in a situation with (90–92%) or without any prosthesis (70%). There was no consensus for the total antibiotic regimen duration, with prescriptions from six to 12 weeks for a majority of respondents. Conclusions Surgical strategy for the management of PJI was homogenous with a preference for a one-stage exchange strategy. Medical management was more heterogenous, which reflects the heterogeneity of those infections and difficulties to perform studies with strong conclusions.

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Section: Surgical Managementmentioning

confidence: 71%

Management of prosthetic joint infections in France: a national audit to identify key situations requiring innovation and homogenization

et al. 2021

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“…A total of 37 studies reported the recurrence of infection [ 6 , 8 , 9 , 13 – 20 , 22 – 25 , 27 – 36 , 38 – 49 ]. Van den Kieboom et al [ 44 ] included both superficial and deep infections.…”

Section: Resultsmentioning

confidence: 99%

“…Compared with two-stage revision, single-stage revision is more conducive to the functional recovery of the affected limb, reduces the occurrence of complications, reduces the overall treatment cost, reduces the surgical trauma, and improves patient satisfaction [ 5 – 7 ]. Moreover, several studies have reported comparable success with single-stage revision versus two-stage revision [ 6 , 8 , 9 ]. However, the evidence regarding single- and two-stage revision for PJI is inconsistent.…”

Section: Introductionmentioning

confidence: 99%

Systematic review and meta-analysis of single-stage vs two-stage revision for periprosthetic joint infection: a call for a prospective randomized trial

Zhao,

Fan,

Wang

et al. 2024

BMC Musculoskelet Disord

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Background Periprosthetic joint infection (PJI) is a severe complication of joint arthroplasty that causes significant pain and economic loss. This study aimed to determine whether the current evidence supports single-stage revision for PJI based on reinfection and reoperation rates. Methods We searched the PubMed, EBSCO, Medline, and Cochrane Library databases from inception to 30 May 2023 to identify studies that compared single-stage revision and two-stage revision for PJI. Data on reinfection and reoperation rates were pooled. Results This meta-analysis included a total of 40 studies with 8711 patients. Overall, there was no significant difference between single- and two-stage revision regarding the postoperative reinfection rate and reoperation rate. Subgroup analysis by surgery period and different surgical sites revealed no difference between the two groups in the reinfection and reoperation rates. Conclusions Based on the available evidence, our study did not identify a significant difference in reinfection and reoperation rates between single- and two-stage revision for PJI. Given the limitations in inclusion/exclusion criteria and the observed heterogeneity, we acknowledge the complexity of drawing strong conclusions. Therefore, we suggest that the choice between single- and two-stage revision should be carefully considered on an individual basis, taking into account patient-specific factors and further research developments.

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“…PJI remains a formidable complication, posing significant challenges for both patients and healthcare professionals. PJIs can lead to pain, functional impairment, prolonged hospital stays, increased healthcare costs, and in severe cases, necessitate implant revision, arthrodesis, or amputation [1,3,4]. Two distinct approaches for managing PJIs have emerged as primary strategies: two-stage revision and one-stage revision.…”

Section: Introductionmentioning

confidence: 99%

“…Advantages of one-stage revision are that it is only a single procedure and reduces the patient's time without a functioning knee. The choice between these two strategies has had varying opinions among orthopedic surgeons and infectious disease specialists regarding their efficacy and long-term outcomes [1,[3][4][5][6]. Furthermore, understanding the microbiology of PJIs is essential in devising effective treatment and prevention strategies.…”

Section: Introductionmentioning

confidence: 99%

A Meta-Analysis of Success Rates of One-Stage Versus Two-Stage Revisions in Knee Prosthetic Joint Infections

Patel,

Shannon,

Sharma

et al. 2024

Cureus

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Prosthetic joint infections (PJIs) pose significant challenges following total joint arthroplasties and cause profound complications. They are associated with significant morbidity and mortality. One-stage revision involves the removal of the infected implant and simultaneous re-implantation of a new prosthesis in a single surgical procedure. The two-stage approach is traditionally more common in the United States and follows a deliberate sequence: the infected implant is first removed, followed by a period of antibiotic therapy, and then a second surgery for implant reinsertion. While two-stage revisions were traditionally considered the gold standard, recent advancements have introduced one-stage revisions as a viable alternative. One-stage revision offers the advantage of being a single procedure, significantly reducing the patient's downtime without a functioning knee. Currently, there has not been a comprehensive exploration of the comparative outcomes between two-stage revisions and one-stage revisions. This systematic review and meta-analysis aimed to assess the outcomes of both one-and two-stage revisions for total knee arthroplasties (TKAs), by utilizing comparison studies as the foundation for analysis. Our search encompassed databases such as MEDLINE (Medical Literature Analysis and Retrieval System Online), Embase, and Cochrane to identify articles examining the comparative efficacy and outcomes of one-and two-stage revision procedures between January 2000 and June 2023. We employed keywords relevant to knee PJIs to identify comparative studies reporting on success rates, reinfection rates, microbiological findings, and other pertinent outcomes. Statistical analysis for this investigation was performed using Review Manager 5.4 (The Cochrane Collaboration, 2020) with a standard significance threshold set at a pvalue less than .05. This meta-analysis incorporated six comparison articles and 802 patients. Two-stage revisions (547 patients) were associated with greater success rates (i.e., infection eradication) than one-stage revisions (255 patients) (p = .03). The studies did not suggest a difference in the microbiology of the infections. Two-stage revisions are associated with higher success rates than one-stage revisions in the treatment of knee PJIs. Future randomized controlled trials should evaluate the optimization of the management of these complications.

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One-stage versus two-stage prosthesis replacement for prosthetic knee infections

Cited by 7 publications

References 26 publications

Management of prosthetic joint infections in France: a national audit to identify key situations requiring innovation and homogenization

Management of prosthetic joint infections in France: a national audit to identify key situations requiring innovation and homogenization

Systematic review and meta-analysis of single-stage vs two-stage revision for periprosthetic joint infection: a call for a prospective randomized trial

A Meta-Analysis of Success Rates of One-Stage Versus Two-Stage Revisions in Knee Prosthetic Joint Infections

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