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

Abstract

Periprosthetic joint infection (PJI) remains one of the most common causes of revision knee arthroplasty. Controversy continues to surround the proper operative technique of PJI in knee arthroplasty with single- or two-stage replacement. Significant variations are seen in the eradication rates of PJI and in implant survival rates. This detailed retrospective analysis of a single tertiary center is intended to provide further data and insight comparing single- and two-stage revision surgery. A retrospective analysis of all revision total knee arthroplasty (TKA) surgeries from 2013 to 2019 was performed and screened with respect to single- or two-stage TKA revisions. Single- and two-stage revisions were analyzed with regard to implant survival, revision rate, microbiological spectrum, and other typical demographic characteristics. A total of 63 patients were included, with 15 patients undergoing single-stage revision and 48 patients undergoing two-stage revision. The mean follow-up time was 40.7 to 43.7 months. Statistically, no difference was found between both groups in overall survival (54.4% vs. 70.1%, p = 0.68) and implant survival with respect to reinfection (71.4% vs. 82.4%, p = 0.48). Further, high reinfection rates were found for patients with difficult-to-treat organisms and low- to semi-constrained implant types, in comparison to constrained implant types. A statistically comparable revision rate for recurrence of infection could be shown for both groups, although a tendency to higher reinfection rate for single-stage change was evident. The revision rate in this single-center study was comparably high, which could be caused by the high comorbidity and high proportion of difficult-to-treat bacteria in patients at a tertiary center. In this patient population, the expectation of implant survival should be critically discussed with patients.

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.…”

“…Eighteen clinical studies [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] were included in the final analysis (Fig. 1) [17].…”

Microbiological Advantages of Open Incisional Biopsies for the Diagnosis of Suspected Periprosthetic Joint Infections

“…Although two-stage revision concepts ensure satisfactory long-term results [ 21 , 22 , 23 ], one-stage revision approaches are of particular interest [ 24 , 25 ] due to reduced functional impairment and mortality [ 23 , 26 ]. Overall, treatment failure for re-infection rates following arthroplasty exchange ranges between 10% and 25% [ 27 , 28 , 29 ]. For years, most authors attributed the sufficient treatment of PJI solely to multiple-stage revision approaches [ 18 , 19 , 27 , 30 ].…”

“…Overall, treatment failure for re-infection rates following arthroplasty exchange ranges between 10% and 25% [ 27 , 28 , 29 ]. For years, most authors attributed the sufficient treatment of PJI solely to multiple-stage revision approaches [ 18 , 19 , 27 , 30 ]. However, recent data prove satisfactory treatment results following single-stage revision surgery as long as patients are adequately selected for eligibility [ 28 , 31 ].…”

Antibiotics in Orthopedic Infections

“…Tuecking et al performed a detailed revision risk analysis after single- vs. two-stage revision surgery in the management of knee PJIs [ 7 ]. No significant difference was found between both groups in overall and implant survival with respect to reinfection.…”