A case for one-stage revision in infected total knee arthroplasty?

Parkinson, R.W.; Kay, PR; Rawal, Arvind

doi:10.1016/j.knee.2010.04.008

Cited by 70 publications

(55 citation statements)

References 18 publications

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“…Standardized diagnostic and therapeutic algorithms for one-stage exchange have been described to make multicenter studies possible with comparable cohorts [13]. Two-stage revision with mobile or static spacers requires at least two surgeries, a longer period of time with limited mobility in the interval, and more possibility for perioperative complications and morbidity [24,28,32,39].…”

Section: Discussionmentioning

confidence: 99%

Can Good Infection Control Be Obtained in One-stage Exchange of the Infected TKA to a Rotating Hinge Design? 10-year Results

Zahár

Kendoff

Klatte

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Prosthetic joint infection (PJI) occurs in 1% to 2% of total knee arthroplasties (TKAs). Although two-stage exchange is the preferred management method of patients with chronic PJI in TKA in North America, one-stage exchange is an alternative treatment method, but long-term studies of this approach have not been conducted. Questions/purposes We reviewed our minimum 9-year results of 70 patients who underwent one-stage exchange arthroplasty with a rotating hinge design to determine: (1) What was the proportion of patients free of infection? (2) What was the patient rate of survival free of any reoperation? (3) What were the clinical outcomes as measured by Hospital for Special Surgery scores? (4) What proportion of patients developed radiographic evidence of loosening? Methods All one-stage revision TKAs for infection between January 1 and December 31, 2002, with a minimum 9-year followup (mean, 10 years; range, 9-11 years), in which patients had been seen within the last 1 year, were included in this retrospective review. During that period, 11 patients with infected TKAs were treated with other approaches (including two-stage approaches in eight); the general indication for one-stage revision was the diagnosis of PJI with a known causative organism. Exclusion criteria were culture-negative preoperative aspiration, known allergy to local antibiotics or bone cement, or cases in which radical débridement was impossible as a result of the involvement of important anatomical structures. Eightyone patients with PJI were seen during this period; 70 underwent one-stage exchange using our strict protocol and were reimplanted with a rotating hinge TKA. Eleven patients (15.7%) were lost to followup. Hospital for Special Surgery scores were recorded and all radiographs were evaluated for prosthetic loosening. Failure was defined as revision surgery for infection or any other cause. Results Our 10-year infection-free survival was 93% (mean, 4.1; 95% confidence interval [CI], 89%-96%; p\0.007); and the patient 10-year survival rate free of revision for other causes was 91% (mean, 5.2; 95% CI, 86%-95%; p\0.002). Mean Hospital for Special Surgery knee score at last followup was 69.6 (± 22.5 SD; range, 22-100) and the mean improvement in Hospital for Special Surgery knee score from preoperative to most recent followup was 35 (± 24.2 SD; range, 13-99). Evidence of radiographic loosening was seen in 11 patients at last followup, whereby in six patients, there was need for revision surgery.Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Clinical Orthopaedics and Related Research 1 neith...

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Section: Discussionmentioning

confidence: 99%

Can Good Infection Control Be Obtained in One-stage Exchange of the Infected TKA to a Rotating Hinge Design? 10-year Results

Zahár

Kendoff

Klatte

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…Major invasive surgical intervention is usually required in the management of such cases. A two-stage revision process, signified by removal of the infected prosthesis, implantation of an antibiotic impregnated cement spacer, followed by a delayed re-implantation of prosthesis procedure, was widely the accepted management goldstandard [10] . The success of single stage revision surgery for the infected hip prosthesis, has led to a recent re-emergence of studies demonstrating similar successful outcomes with one-stage procedures for perisprosthetic knee infections [11] .…”

Section: Introductionmentioning

confidence: 99%

Crystal Arthropathy following Knee Arthroplasty: A Review of the Literature

Khalfaoui

Yassa

2015

International Journal of Orthopaedics

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“…The preliminary result of one-stage revision knee arthroplasty was presented in the British Association for Surgery of the Knee Spring Meeting [18]. Recent literature search yields encouraging results for one-stage revision knee arthroplasty for infection [19,20] although more research is required. The recently concluded international consensus on peri-prosthetic joint infection supports our views on single-stage excision arthroplasty for infection.…”

Section: Discussionmentioning

confidence: 99%