High Infection Control Rate and Function After Routine One-stage Exchange for Chronically Infected TKA

Jenny, Jean–Yves; Bruno, Benedetto; Gaudias, J.; Boéri, Cyril; Argenson, Jean-Noël

doi:10.1007/s11999-012-2480-7

Cited by 62 publications

(38 citation statements)

References 20 publications

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“…However, only ''easy'' infected cases (''easy'' considered having good soft tissue, no bone loss, no sinus germs, and no multiresistant germ as a pathogen) were included in the one-stage group. Similar results were found by Jenny et al [20] in 42 patients after one-stage exchange. At latest followup, the median Knee Society knee score was 85 points (range, 10-100 points), the median Knee Society pain score was 45 points (range, 10-50 points), and the median Knee Society function score was 78 points (range, 0-100 points).…”

Section: Discussionsupporting

confidence: 90%

“…The results for pain (maximum of 30 points) were a mean preoperative 5.7 (± 9.9; range, 0-30) and improved significantly postoperatively to 18.5 points (± 11.3; range, 0-30). A significant improvement was also found regarding the function preand postoperatively with a mean 10 points preoperatively (± 6; range, 4-22) and 16.7 (± 6.3; range, [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] postoperatively.…”

Section: Resultsmentioning

confidence: 99%

“…Some studies have shown possible advantages of one-stage exchange for the infected TKA in selected patients [14], including the need for only one surgical procedure, shorter hospitalization time, reduced time on antibiotic therapy, reduced overall costs, and improved patient satisfaction [16,29,39,40]. In addition, an increasing number of publications have reported on one-stage exchange in TKA and THA within the last few years, showing high success rates [14,20,36,39,40]. However, these publications share certain limitations: small numbers of patients (\ 20); short followup (\5 years); and strict exclusion criteria such as multiresistant organism-based infections, reinfection, significant bone loss, relevant comorbidities, sinus tract, and other relevant soft tissue complications [26].…”

Section: Introductionmentioning

confidence: 99%

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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: Discussionsupporting

confidence: 90%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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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“…As outlined by a recent systematic review on the subject, the majority of the publications are noncomparative observational studies with studies regarding 2-stage arthroplasty outnumbering those for 1-stage arthroplasty [48]. The reinfection rate for 1-stage and 2-stage arthroplasty was reported as 0 %-13 % and 0 %-41 %, respectively, which also depends on the length of follow-up [48][49][50]. Both approaches have been reported to be highly successful and their success rate depends highly on the expertise and experience of the treating surgeon.…”

Section: Treatmentmentioning

confidence: 99%

Infection post-total knee replacement: current concepts

Alijanipour

Parvızı

2014

Curr Rev Musculoskelet Med

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Periprosthetic joint infection is a hot topic for investigation because it represents a challenging clinical problem with considerable burden for patients, institutions, and health systems. Despite our substantial knowledge, many details in prevention, pathophysiology, diagnosis, and treatment of infectious complications following total knee arthroplasty remain to be controversial with the available evidence being insufficient and at times conflictive. This manuscript is an attempt to approach the most recently published literature regarding the aforementioned details and aims to provide the reader with an updated perspective in the management of periprosthetic joint infection of the knee.

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“…Patients treated with one-stage exchange arthroplasty demonstrated high functional outcome scores, high success of infection eradication, and cost savings for undergoing only one surgical procedure in specific patient populations [6,9]. While two-stage exchange arthroplasty for treating PJI has been widely reported, fewer studies report the results of one-stage exchange arthroplasty, and the success rate of surgery is variable [7,8].…”

mentioning

confidence: 99%

CORR Insights®: One-stage Revision With Catheter Infusion of Intraarticular Antibiotics Successfully Treats Infected THA

Chen

2017

Clinical Orthopaedics &Amp; Related Research

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High Infection Control Rate and Function After Routine One-stage Exchange for Chronically Infected TKA

Abstract: Background Many surgeons consider two-stage exchange the gold standard for treating chronic infection after TKA. One-stage exchange is an alternative for infection control and might provide better knee function, but the rates of infection control and levels of function are unclear.

Cited by 62 publications

References 20 publications

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

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

Infection post-total knee replacement: current concepts

CORR Insights®: One-stage Revision With Catheter Infusion of Intraarticular Antibiotics Successfully Treats Infected THA

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