Repeat two‐stage revision for knee prosthetic joint infection results in very high failure rates

Abstract

Introduction Two stage revision total knee arthroplasty (TKA) is the gold standard for treatment and eradication of knee prosthetic joint infections (PJI), but the literature is limited on the outcomes of repeat two‐stage TKA after PJI recurrence. This study presents the outcomes of repeat two‐stage revision TKA and investigates potential factors contributing to success or failure, aiming to assist counselling and decision‐making. Methods A retrospective study was undertaken investigating all two‐stage revision TKA performed at one institution between 2005 and 2020. Twenty cases underwent repeat two‐stage revision TKA. Patient outcomes and factors contributing to treatment success or failure were investigated. PJI was diagnosed according to MSIS criteria. Results Of the 20 cases, 14 were classified as failed treatment (70%) due to a failure to eradicate infection, further surgical intervention or death. In this cohort, there were no statistically significant differences between the groups regarding factors contributing to treatment success or failure. In the success group, patient reported functional outcomes were variable. Conclusion This study demonstrates that patients undergoing a repeat two‐stage TKA have very poor outcomes. This study did not identify any factors that predicted failure. Patients need to be counselled regarding poor outcomes with repeat two‐stage TKA, and other treatment options such as early amputation or lifelong suppression should be considered.

Silver-Coated Distal Femur Megaprosthesis in Chronic Infections with Severe Bone Loss: A Multicentre Case Series

“…In particular, the reinfection rate in this study was 17.8%, with a mean follow-up of 43 ± 17.1 months, also considering the high amount of already recurrent infections in the study population (62.2%). This appears to be a satisfactory result, as the failure rate of the two-stage procedure to treat chronic infection recurrence at the knee, even without bone resection, is reported to be up to over 70% [47][48][49]. The overall reinfection rate after DF MP in non-oncological settings was reported to be 7.9% in a recent review by Sambri et al [6].…”

Change in organism between first- and second-stage revision for periprosthetic joint infection of knee arthroplasty independently associated with increased risk of failure

“…[12][13][14][15] the available literature on repeat two-stage revisions for tKA infection is based on small cohorts or single centres reporting variable success rates and varying follow-up periods. 8,10,[16][17][18][19] Kim et al 20 have contended that culture outcome (positive vs negative) does not influence the outcome from two-stage revision, as measured by the likelihood of further surgical intervention. However, yang et al 21 demonstrated that prolonged postoperative microorganism directed antibiotics following two stage revision tKAs is associated with a significantly reduced likelihood of further infection.…”