The PROSTALAC functional spacer in two-stage revision for infected knee replacements

Haddad, Fares S.; Masri, Bassam A.; Campbell, D.; McGraw, Robert W.; Beauchamp, C.P.; Duncan, Clivе P.

doi:10.1302/0301-620x.82b6.10486

Cited by 210 publications

(89 citation statements)

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“…An earlier study from 2000 from the same centre of 45 patients demonstrated a 91% infection clearance rate [36], with mean follow up of 48 months (20–112 months). Similarly Haleem and colleagues studied 96 knees in 94 patients with a median follow up of 7.2 years [37].…”

Section: Resultsmentioning

confidence: 99%

A systematic review of the evidence for single stage and two stage revision of infected knee replacement

Masters

Smith

Foguet

et al. 2013

BMC Musculoskelet Disord

123

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BackgroundPeriprosthetic infection about the knee is a devastating complication that may affect between 1% and 5% of knee replacement. With over 79 000 knee replacements being implanted each year in the UK, periprosthetic infection (PJI) is set to become an important burden of disease and cost to the healthcare economy. One of the important controversies in treatment of PJI is whether a single stage revision operation is superior to a two-stage procedure. This study sought to systematically evaluate the published evidence to determine which technique had lowest reinfection rates.MethodsA systematic review of the literature was undertaken using the MEDLINE and EMBASE databases with the aim to identify existing studies that present the outcomes of each surgical technique. Reinfection rate was the primary outcome measure. Studies of specific subsets of patients such as resistant organisms were excluded.Results63 studies were identified that met the inclusion criteria. The majority of which (58) were reports of two-stage revision. Reinfection rated varied between 0% and 41% in two-stage studies, and 0% and 11% in single stage studies. No clinical trials were identified and the majority of studies were observational studies.ConclusionsEvidence for both one-stage and two-stage revision is largely of low quality. The evidence basis for two-stage revision is significantly larger, and further work into direct comparison between the two techniques should be undertaken as a priority.

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Section: Resultsmentioning

confidence: 99%

A systematic review of the evidence for single stage and two stage revision of infected knee replacement

Masters

Smith

Foguet

et al. 2013

BMC Musculoskelet Disord

123

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show abstract

“…Finally, 25 original studies published in English (Rosenberg et al 1988, Booth and Lotke 1989, Henderson et al 1991, Göksan and Freeman 1992, Masri et al 1994, Whiteside 1994, Gusso et al 1995, Goldman et al 1996, McPherson et al 1997, Hirakawa et al 1998, Fehring et al 2000, Haddad et al 2000, Mont et al 2000, Lonner et al 2001, Emerson et al 2002, Siebel et al 2002, Jhao and Jiang 2003, Buechel et al 2004, Durbhakula et al 2004, Haleem et al 2004, Meek et al 2004, Cuckler 2005, Hofmann et al 2005, MacAvoy and Ries 2005, Pitto et al 2005) and 6 studies published in other languages (von Foerster et al 1991, Gacon et al 1997, Lu et al 1997, Lecuire et al 1999, Kirschner et al 2000, Pietsch et al 2003) between 1983 and 2005 were included. The materials of several studies (Insall et al 1983, Wilde and Ruth 1988, Hofmann et al 1995, 2005, Goldman et al 1996, Hirakawa et al 1998, Windsor et al 2000, Meek et al 2003, 2004) were identical.…”

Section: Methodsmentioning

confidence: 99%

Outcome of prosthesis exchange for infected knee arthroplasty: the effect of treatment approach

Jämsen

Stogiannidis

Malmivaara³

et al. 2009

Acta Orthopaedica

174

109

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Background and purpose Two-stage revision remains the gold standard in the treatment of infected knee arthroplasty. Lately, good long-term results of direct exchange arthroplasty have been reported. The purpose of this literature review is to compare the clinical outcome achieved with one-stage revision and two-stage revision with different types of spacers.Methods A thorough systematic review of literature was undertaken to idenepsy reports on the treatment alternatives. Papers written in English or including an English abstract, published from 1980 through 2005, and reporting either the success rate in eradication of infection or the clinical status achieved were reviewed. 31 original articles describing the results of 154 one-stage exchange arthoplasties and of 926 two-stage exchange arthoplasties were included. The depth of detail in the description of materials and methods varied markedly, making it impossible to perform a meta-analysis. Instead, a descriptive review of the results is presented.Results With a follow-up of 12–122 months, the overall success rate in eradication of infection was 73–100% after one-stage revisions and 82–100% after two-stage revisions. Reinfection rates were the lowest in series where articulating cement spacers were used, though the follow-up was relatively short. Studies using articulating spacers reported the highest average postoperative ranges of motion. Otherwise, no correlations were observed between the clinical outcome and the length of follow-up, the type of revision, or the type of spacer. The clinical outcome (knee scores and range of motion) of the one-stage revisions was no different from that of the two-stage revisions.Interpretation Two-stage exchange is an effective treatment. Mobile spacers may further improve the range of motion. More experience in one-stage revision is required in order to define its role in the management of infected knee arthroplasties.

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“…A two-stage revision or exchange arthroplasty, involving removal of the prosthesis, administration of local and systemic antibiotics and then reimplantation after eradicating the infection, has become the uncontested “gold” standard in management of PJI with success rates over 90% [5, 6]. It is therefore understandable that there is only a handful of series looking at the outcomes of one-stage exchange arthroplasty since Buchholz’s study from The ENDO-Klinik in Hamburg was published in 1981 [6].…”

Section: Introductionmentioning

confidence: 99%

One-stage Exchange Arthroplasty for Periprosthetic Hip and Knee Joint Infections

Nguyen¹,

Sukeik²,

Zahár³

et al. 2016

TOORTHJ

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Background:Periprosthetic joint infection (PJI) is a devastating complication of joint replacement surgery. In an aging population of the developed world, the increasing numbers of hip and knee replacements will inevitably lead to increasing incidence of PJI, carrying with (it) significant patient morbidity and cost to the health care system. Two-stage exchange arthroplasty is currently the gold standard but it is associated with multiple operations, prolonged hospitalization and impaired functionality. One-stage exchange arthroplasty is similar to the two-stage procedure but the interval between removal of the prosthesis and reimplantation of a new one is only a few minutes. It has the theoretical benefits of a single anesthetic, shorter hospitalization, less cost and improved function.Methods:We reviewed the current literature regarding the outcomes of one-stage exchange arthroplasties focusing on re-infection rates and functional outcomes.Results:Current themes around the one-stage exchange procedure include the indications for the procedure, definition of re-infection, surgical techniques used to provide fixation and differences in approach for hip and knee replacements.Conclusion:The current literature on one-stage exchange procedure is promising, with comparable results to two-stage revisions for hips and knees in selected patients. However, there is a great need for a large multi-centred randomized control trial, focusing on re-infection rates and functional scores postoperatively, to provide concrete guidelines in managing this complex condition.

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The PROSTALAC functional spacer in two-stage revision for infected knee replacements

Cited by 210 publications

References 0 publications

A systematic review of the evidence for single stage and two stage revision of infected knee replacement

A systematic review of the evidence for single stage and two stage revision of infected knee replacement

Outcome of prosthesis exchange for infected knee arthroplasty: the effect of treatment approach

One-stage Exchange Arthroplasty for Periprosthetic Hip and Knee Joint Infections

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