One-stage reimplantation for infected total knee arthroplasty

Abstract

One-stage reimplantation for the salvage of infected total knee arthroplasty in 18 patients was reviewed at an average follow-up of five years. There had been one recurrence and one new infection, both in rheumatoid patients with another focus of infection. In four other patients the clinical result was impaired by pain after walking (2) and limited flexion (2). Our results suggest that one-stage reimplantation is a reasonably reliable procedure for the management of a loose infected prosthesis.

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

“…Control of the index infection was obtained in 94% of our patients, and 85% were free of any knee infection after 3 years. These figures are comparable to those of other one- [1,2,7,16,21,23] and two-stage studies [1,3,21,22,24] considering control of infection. Several factors may have contributed to our encouraging success rate at 3 years: high number of methicillin-sensitive organisms, systematic use of antibiotic-loaded cement, and prolonged oral antibiotic regimen according to well-proven protocols [5].…”

“…Second, the number of patients was too small to perform an adequately powered analysis of prognostic factors. However, the number of included patients is higher than in most other studies [1,2,7,16,20,23] reporting one-stage exchange of infected TKAs. Further, no patient was lost of followup.…”

“…Few papers have reported findings after one-stage exchange of infected TKA. A recent systematic review of the literature [9] retrieved only four studies [2,7,16,23], some of them limited to fewer than 20 TKAs and with only one published in the last decade [2], collecting in total 152 TKAs. Von Foerster et al [23] published the study with the largest number of TKAs (104) available for followup and reported a rate of infection control of 73% after one-stage exchange and fixation of the new prosthesis with antibiotic-loaded cement.…”

The Chitranjan Ranawat Award: Fate of Two-stage Reimplantation After Failed Irrigation and Débridement for Periprosthetic Knee Infection

“…Methods used for the initial treatment of periprosthetic knee infection include irrigation and débridement (I&D) with component retention (Table 1) [3-5, 7, 14, 19, 24, 26, 28, 30, 32, 35], direct-exchange arthroplasty [10,34], and two-stage resection arthroplasty and reimplantation [1, 2, 6, 8, 9, 11-13, 16-18, 25, 27, 30, 33-37]. Two-stage revision, which includes interval use of antibiotic-loaded cement spacers and intravenous antibiotics and the use of antibioticloaded cement for prosthesis fixation at reimplantation, has become the gold-standard treatment in the United States, with infection-free survival rates of 80% to 100% (Table 2) [1, 2, 6, 8, 9, 11-13, 16-18, 25, 27, 30, 33-37].…”

Assessing the Gold Standard: A Review of 253 Two-Stage Revisions for Infected TKA

“…The rate of periprosthetic infection has been declining over the last two to three decades, mostly due to operating room environments and operative techniques [17,27,40]. Various methods have been used in the initial treatment of periprosthetic knee infection, including irrigation and debridement [10,11,38], direct exchange arthroplasty [6,16], and two-stage revision TKA with subsequent reimplantation [15,18]. Incision and drainage has been an attractive option, with low cost and relatively low morbidity; however, the failure rate has been high, ranging between 61% and 82% [4,5,7,23,30,35,38,39,41,44].…”