Single-stage revision for the infected total knee arthroplasty

Abstract

Aims Periprosthetic joint infection (PJI) is a devastating complication following total knee arthroplasty (TKA). Two-stage revision has traditionally been considered the gold standard of treatment for established infection, but increasing evidence is emerging in support of one-stage exchange for selected patients. The objective of this study was to determine the outcomes of single-stage revision TKA for PJI, with mid-term follow-up. Methods A total of 84 patients, with a mean age of 68 years (36 to 92), underwent single-stage revision TKA for confirmed PJI at a single institution between 2006 and 2016. In all, 37 patients (44%) were treated for an infected primary TKA, while the majority presented with infected revisions: 31 had undergone one previous revision (36.9%) and 16 had multiple prior revisions (19.1%). Contraindications to single-stage exchange included systemic sepsis, extensive bone or soft-tissue loss, extensor mechanism failure, or if primary wound closure was unlikely to be achievable. Patients were not excluded for culture-negative PJI or the presence of a sinus. Results Overall, 76 patients (90.5%) were infection-free at a mean follow-up of seven years, with eight reinfections (9.5%). Culture-negative PJI was not associated with a higher reinfection rate (p = 0.343). However, there was a significantly higher rate of recurrence in patients with polymicrobial infections (p = 0.003). The mean Oxford Knee Score (OKS) improved from 18.7 (SD 8.7) preoperatively to 33.8 (SD 9.7) at six months postoperatively (p < 0.001). The Kaplan-Meier implant survival rate for all causes of reoperation, including reinfection and aseptic failure, was 95.2% at one year (95% confidence interval (CI) 87.7 to 98.2), 83.5% at five years (95% CI 73.2 to 90.3), and 78.9% at 12 years (95% CI 66.8 to 87.2). Conclusion One-stage exchange, using a strict debridement protocol and multidisciplinary input, is an effective treatment option for the infected TKA. This is the largest single-surgeon series of consecutive cases reported to date, with broad inclusion criteria. Cite this article: Bone Jt Open 2021;2(5):305–313.

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

“…As other studies have shown [29,30], patient selection for single-stage revisions remains critical. Polymicrobial infections are a major factor.…”

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.…”

Effective single-stage revision using intra-articular antibiotic infusion after multiple failed surgery for periprosthetic joint infection

“…11 Single-stage revision has been used in the treatment of chronic PJIs to overcome technical difficulties in staged revision surgery, accelerate restoration of function, reduce morbidity, and decrease cost. [12][13][14] Zahar et al 15 recently reported the ten-year infection-free survival was 94% following single-stage septic hip exchange with an antibioticloaded bone cemented prosthesis due to PJI. We hypothesized that the combination of single-stage revision and intra-articular antibiotic infusion may be a feasible approach for PJIs after multiple failed prior surgeries for reinfection (PMFSR).…”