One-stage revision is as effective as two-stage revision for chronic culture-negative periprosthetic joint infection after total hip and knee arthroplasty

Kieboom, Janna van den; Tirumala, Venkatsaiakhil; Box, Hayden N.; Oganesyan, Ruben; Klemt, Christian; Kwon, Young‐Min

doi:10.1302/0301-620x.103b.bjj-2020-1480.r2

Cited by 49 publications

(44 citation statements)

References 48 publications

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“…This might be essential, especially in cases with concurrent high risk factors (poor bone stock or poor soft tissue status). Nevertheless, negative preoperative cultures in single-stage revisions do not necessarily have to be an exclusion criterion, as recently shown by van den Kieboom et al [15]. Moreover, the possibility of one-stage revision should be considered as an option despite the presence of risk factors regarding reinfection, especially in patients with increased perioperative mortality risk.…”

Section: Discussionmentioning

confidence: 96%

“…Reported reinfection rates vary from 7.6% to 38.25% [14], regardless of the technique used. Lately, several studies report comparable outcomes and reinfection rates for direct comparison of single-vs. two-stage revision arthroplasty [15][16][17]. Nevertheless, there are still uncertainties, for example, regarding the influence of patient selection and indication criteria for single-stage TKA revision [17,18].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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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.

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Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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“…This prompts us to favor single-stage revision surgery instead of the cumbersome two-stage revision surgery. There is now evidence from several comparative case series that complications and reinfection rates after single-stage revisions are similar to those in two-stage revisions [11][12][13][14]. Revision surgery protocols of PJI, designed to address the nature of these infections, were first introduced over three decades ago.…”

Section: Discussionmentioning

confidence: 99%

COVID-19 Collateral Damage: Management of Periprosthetic Joint Infection in Malaysia

Khan¹,

Kow²,

Ramalingam³

et al. 2021

Cureus

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Background and objectivePeriprosthetic joint infection (PJI) is one of the dreaded complications in patients after arthroplasty surgeries, owing to the risk of morbidity and arduous investigations and management associated with it. Nevertheless, as Malaysia is currently battling against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-induced coronavirus disease 2019 (COVID-19) pandemic head-on, the treatment for other non-life-threatening diseases including PJI has taken a backseat. In this study, we present a case series of 11 patients with PJI who were managed surgically at the largest tertiary hospital in Malaysia and we hope to shed some light on the difficulties we have encountered during this trying period. Patients and methodsPatients with PJIs who underwent surgical intervention during the ongoing COVID-19 pandemic (March 1, 2020, to June 30, 2021) were reviewed and included in this study. The demographic profile of the patients, presenting complaints, prosthesis topography, biochemical investigative findings, surgical interventions, and short-term outcomes were summarized. ResultsA total of 11 patients were treated surgically at Hospital Kuala Lumpur for PJI. Among them, five patients are still awaiting their second-stage surgeries despite the completion of their antibiotic regimes, and they are fit for the procedure. ConclusionThe COVID-19 pandemic has wreaked havoc on the treatment of patients with PJI. In a setting with scarce resources, surgeons should strongly consider single-stage revision surgeries for the treatment of patients with PJI.

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“…For early acute periprosthetic infections, debridement, antibiotics and implant retention (DAIR) is maybe an effect way, but without doubt, bacteria drug resistance affects the outcome of DAIR 4 . Although one‐stage revision has had success in many medical centers, and even been reported an effective way for chronic PJI 5 , two‐stage revision has been accepted by many scholars. Antibiotic‐loaded cement spacers for local administration is a standard method in two‐stage revision, and its success rate is close to 90% 6 , 7 , 8 .…”

Section: Introductionmentioning

confidence: 99%

“…However, gentamicin resistance has become increasingly prominent 16 , and gentamicin is usually ineffective for most anaerobic infections. In addition to culture‐positive PJI, there is another clinical situation, which is culture‐negative PJI 5 . For culture‐negative PJI, antibiotics loaded to bone cement probably need to cover positive bacteria, drug‐resistant negative bacteria and anaerobes.…”

Section: Introductionmentioning

confidence: 99%

Elution and Biomechanical Properties of Meropenem‐Loaded Bone Cement

Wang

Feng

Zhang

et al. 2021

Orthopaedic Surgery

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Objective: To investigate the biomechanical and elution properties of meropenem-loaded bone cement.Methods: Bone cement (Palacos LV) with 5% (2 g/4 0g), 10% (4 g/40 g), and 15% (6 g/40 g) meropenem; 5%(2 g/40 g) and 10% (4 g/40 g) vancomycin; and blank bone cement were prepared in a total of six groups named A2, A4, A6, B2, B4, and A0 (antibiotic-free). 36 cylinder specimens (6-mm diameter and 12-mm height) of all six groups were molded for a compression test. After the compression test, because of mechanical properties below the ISO standard requirements, groups B2, B4 were not subjected to a bending test. So a total of 24 rectangular strip specimens (10-mm width, 75-mm length, and 3.3-mm thickness) for groups A2, A4, A6 and A0 were molded for the bending test. Between-group differences of compressive strength, bending strength and bending modulus were analyzed. The meropenem standard was prepared as a series of standard solutions to calculate the standard curve. At a constant temperature of 37 C, separately, meropenem-loaded bone cement cylinder specimens (12 mm in diameter and 17 mm in length) of A2, A4 and A6 were serially immersed in saline solution without stirring. The eluent drug concentration at 24, 48, 72 h and 6, 12, 24 days was measured and the drug concentration-time curve of meropenem was constructed.Results: With the exception of groups B2 and B4, all cements compressive strength values were well above the minimum requirement of the ISO 5833 standard (70 MPa). The compressive strength and bending strength values of group A4 were higher than those of group A0 (P < 0.05), but no difference was found between the A0, A2 and A6 groups (P > 0.05). There were no intergroup differences of bending modulus between the A0, A2, A4 and A6 groups (P > 0.05). A standard curve of meropenem was obtained and a regression equation was constructed: Y = 15.0265 X + 13.5218, r = 1.00. At 37 C, the release of meropenem was rapid during the first 48 h for all A2, A4, A6 samples, and subsequent release continued to decrease. Conclusion:When adding up to 15% (6 g/40 g) meropenem to the bone cement, the biomechanical properties were not reduced, and bone cement with 10% (4 g/40 g) meropenem had the best performance. At a constant temperature of 37 C, meropenem can be released from bone cement for up to 24 days.

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One-stage revision is as effective as two-stage revision for chronic culture-negative periprosthetic joint infection after total hip and knee arthroplasty

Cited by 49 publications

References 48 publications

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

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

COVID-19 Collateral Damage: Management of Periprosthetic Joint Infection in Malaysia

Elution and Biomechanical Properties of Meropenem‐Loaded Bone Cement

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