Outcomes of infected revision knee arthroplasty managed by two-stage revision in a tertiary referral centre

Stammers, John; Kahane, Steve; Ranawat, Vijai; Miles, Jonathan; Pollock, Rob; Carrington, Richard; Briggs, Timothy; Skinner, John

doi:10.1016/j.knee.2014.10.005

Cited by 31 publications

(25 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Lower eradication rates have been reported in the literature after a second TSR [29], but a high rate of arthrodesis in the second TSRs might be an explanation for this. Isiklar et al recommended arthrodesis instead of multiple revisions in patients with chronic infections, in order to avoid amputation [15].…”

Section: Discussionmentioning

confidence: 80%

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

et al. 2016

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 80%

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

et al. 2016

View full text Add to dashboard Cite

show abstract

“…In two stage surgery, the use of antibiotic-impregnated spacers is considered the gold standard for the eradication of infection and avoiding limb shortening [92,93]. Spacers are bone cement pieces that is placed in the joint place to prevent muscle contractions and preserve their length.…”

Section: Treatmentmentioning

confidence: 99%

Nano-carrier based drug delivery systems for sustained antimicrobial agent release from orthopaedic cementous material

Thaher

Perni

Prokopovich

2017

Advances in Colloid and Interface Science

View full text Add to dashboard Cite

Total joint replacement (TJR), such as hip and knee replacement, is a popular procedure worldwide. Prosthetic joint infections (PJI) after this procedure have been widely reported, where treatment of such infections is complex with high cost and prolonged hospital stay. In cemented arthroplasties, the use of antibiotic loaded bone cement (ALBC) is a standard practice for the prophylaxis and treatment of PJI. Recently, the development of bacterial resistance by pathogenic microorganisms against most commonly used antibiotics increased the interest in alternative approaches for antimicrobial delivery systems such as nanotechnology. This review summarizes the efforts made to improve the antimicrobial properties of PMMA bone cements using nanotechnology based antibiotic and non-antibiotic delivery systems to overcome drawbacks of ALBC in the prophylaxis and treatment of PJIs after hip and knee replacement.

show abstract

“…Once the infection is eradicated, and CRP and ESR levels return to normal, the second surgery is performed to remove the spacer and implant the revision prosthesis. The latter approach may be performed in most cases of PJI [16,17] and has a success rate ranging from 37.1 to 100 % [18][19][20].…”

Section: This Article Is Part Of the Topical Collection On Revision Kmentioning

confidence: 99%

The use of spacers (static and mobile) in infection knee arthroplasty

Mazzucchelli

Rosso

Marmotti

et al. 2015

Curr Rev Musculoskelet Med

View full text Add to dashboard Cite

Revision total knee arthroplasty (TKA) is the treatment of choice in patients with periprosthetic joint infection. It may be performed in either a single stage or two stages. In the latter option, between stages, an antibiotic-loaded spacer may be used to maintain a certain amount of joint stability and mobility after the infected implant is removed, adding an intra-articular concentration of antibiotics. There are two types of antibiotic-loaded cement spacers: static and dynamic. Static spacers basically create a temporary arthrodesis with antibiotic-loaded cement and usually are handmade within the surgical field. Dynamic spacers can be created intraoperatively by using different tools or may be prepackaged by the manufacturer; they allow range of motion between stages. In this article, the authors review the indications, surgical techniques, and results for static and dynamic spacers in two-stage revision TKA.

show abstract

Outcomes of infected revision knee arthroplasty managed by two-stage revision in a tertiary referral centre

Cited by 31 publications

References 38 publications

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

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

Nano-carrier based drug delivery systems for sustained antimicrobial agent release from orthopaedic cementous material

The use of spacers (static and mobile) in infection knee arthroplasty

Contact Info

Product

Resources

About