Re-Infection Outcomes Following One- And Two-Stage Surgical Revision of Infected Knee Prosthesis: A Systematic Review and Meta-Analysis

Abstract

BackgroundPeriprosthetic joint infection (PJI) is a serious complication of total knee arthroplasty. Two-stage revision is the most widely used technique and considered as the most effective for treating periprosthetic knee infection. The one-stage revision strategy is an emerging alternative option, however, its performance in comparison to the two-stage strategy is unclear. We therefore sought to ask if there was a difference in re-infection rates and other clinical outcomes when comparing the one-stage to the two-stage revision strategy.ObjectiveOur first objective was to compare re-infection (new and recurrent infections) rates for one- and two-stage revision surgery for periprosthetic knee infection. Our second objective was to compare between the two revision strategies, clinical outcomes as measured by postoperative Knee Society Knee score, Knee Society Function score, Hospital for Special Surgery knee score, WOMAC score, and range of motion.DesignSystematic review and meta-analysis.Data sourcesMEDLINE, EMBASE, Web of Science, Cochrane Library, reference lists of relevant studies to August 2015, and correspondence with investigators.Study selectionLongitudinal (prospective or retrospective cohort) studies conducted in generally unselected patients with periprosthetic knee infection treated exclusively by one- or two-stage revision and with re-infection outcomes reported within two years of revision surgery. No clinical trials comparing both revision strategies were identified.Review methodsTwo independent investigators extracted data and discrepancies were resolved by consensus with a third investigator. Re-infection rates from 10 one-stage studies (423 participants) and 108 two-stage studies (5,129 participants) were meta-analysed using random-effect models after arcsine transformation.ResultsThe rate (95% confidence intervals) of re-infection was 7.6% (3.4–13.1) in one-stage studies. The corresponding re-infection rate for two-stage revision was 8.8% (7.2–10.6). In subgroup analyses, re-infection rates remained generally similar for several study-level and clinically relevant characteristics. Postoperative clinical outcomes of knee scores and range of motion were similar for both revision strategies.LimitationsPotential bias owing to the limited number of one-stage revision studies and inability to explore heterogeneity in greater detail.ConclusionsAvailable evidence from aggregate published data suggest the one-stage revision strategy may be as effective as the two-stage revision strategy in treating infected knee prostheses in generally unselected patients. Further investigation is warranted.Systematic review registrationPROSPERO 2015: CRD42015017327

Two stage revision hip arthroplasty in periprosthetic joint infection. Comparison study: with or without the use of a spacer

“…The final results of the two stage procedure are satisfactory in terms of function, pain and eradication of infection (9.2%). Two-stage reimplantations have previously been found to successfully eradicate infection in 84-100% [1][2][3], which is consistent with our observations. A systematic review and metaanalysis based on aggregate published data found the reinfection rate after one-or two-stage revision to be approximately 8% [2].…”

“…Two-stage reimplantations have previously been found to successfully eradicate infection in 84-100% [1][2][3], which is consistent with our observations. A systematic review and metaanalysis based on aggregate published data found the reinfection rate after one-or two-stage revision to be approximately 8% [2]. Staphylococcus species were identified in about half of patients, which is consistent with findings provided by Kliushin et al [12].…”

“…The treatment goal is to attempt limb salvage, eradicate infection and preserve joint function. The prognosis for resolving infectious processes in hip arthroplasties ranges from 84 to 100% with current surgical techniques [1][2][3]. The two most common surgical procedures are one-and two-stage revisions.…”

Health Care Needs and Support for Patients Undergoing Treatment for Prosthetic Joint Infection following Hip or Knee Arthroplasty: A Systematic Review

“…Surgical treatments are used in conjunction with the use of powerful intravenous and oral antibiotics. After revision surgery has been performed, reinfection occurs within two years in around 8% of patients requiring further major surgery, lifelong antibiotic suppression or amputation [6–8]. Although PJI affects a small percentage of patients, hip and knee replacements are common and PJI is considered to be one of the most devastating complications associated with this procedure [9].…”

Update on the diagnosis and management of the periprosthetic knee joint infection

“…Post-operative clinical outcomes for knee scores and range of motion were similar for both strategies. 28 Overall, it appears that the final management choice is still surgeon specific and dependent. Although no consensus has been achieved, there do appear to be some general recommendations of when not to perform a single-stage revision, as stated by Oussedik et al and shown in Table 2, which appear to be widely accepted.…”