Single-Stage Revision Surgery in Infected Total Knee Arthroplasty: A PRISMA Systematic Review

Abstract

Periprosthetic joint infection in total knee arthroplasty is a significant complication that is a common reason for revision surgery. The current standard of care is two-stage revision surgery. There is however increasing evidence to support the use of single-stage revision surgery. We conducted a PRISMA systematic review of the current evidence on the use of single-stage revision for infected total knee arthroplasty. Four databases (PubMed, Embase, Science Direct, and Cochrane Library) were systematically screened for eligible studies. The risk bias of each study was identified using ROBINS-I tool, and the quality of evidence was assessed using the GRADE criteria. Sixteen articles were retained after applying the inclusion and exclusion criteria that evaluated 3645 knee single-stage revision surgeries. Our review reveals satisfactory outcomes for single-stage revision in the management of infected total knee arthroplasty. The reinfection rates in the studies included in our review varied however the majority reported low reinfection rates and good functional outcomes. Although strict patient selection criteria have yielded successful results, good results were also reported when these criteria were not applied. The greater use of risk factors in identifying patients likely to have a successful outcome needs to be balanced with the practical benefits of performing a single stage procedure in higher risk patients. Future large clinical randomized control trials are required to confirm our results.

Twenty common errors in the diagnosis and treatment of periprosthetic joint infection

“…PJI has been found to be the most common cause of failure after hip arthroplasty [1] and of early failure after knee replacement [2]. In spite of increased interest and advances in the diagnosis and management of PJI [3][4][5][6][7], it remains a challenge for the treating physicians, and recent meta-analyses have reported microbiological failure rates of 0-40% for one-and two-stage revision for infected hip and knee arthroplasties [8][9][10][11][12]. Failure can be due to patient factors, microbiological factors [13], or factors related to errors during diagnosis and treatment [14,15].…”

Improved treatment strategies can result in better outcomes following one-stage exchange surgery for MRSA periprosthetic joint infection

“…Currently, there are only few studies directly comparing one-stage and two-stage exchange surgeries. The reported success rates in achieving infection control are comparable, with 62–100% for the former and 59–100% for the latter [15–17]. As reported in a systematic review, the average success rate for one-stage surgeries is 85% [17].…”

“…The reported success rates in achieving infection control are comparable, with 62–100% for the former and 59–100% for the latter [15–17]. As reported in a systematic review, the average success rate for one-stage surgeries is 85% [17]. Risk factors for failure of one-stage exchange surgery have been introduced by Citak et al .…”

Prosthesis design of animal models of periprosthetic joint infection following total knee arthroplasty: A systematic review

“…Although through a series of measures [5–8] (including the use of perioperative antibiotics, intraoperative antibiotic cement, intraoperative antibiotic calcium sulfate, improvement of surgical environment, and elimination of local bacterial colonization), the infection rate has been controlled at about 1%-3% [9, 10]. However, with the rapid growth of the population undergoing TKA in recent years, the number of people with PJI has also increased annually [11, 12]. Two-stage revision, involving an antibiotic-impregnated polymethylmethacrylate spacer, is thought to be the gold standard for treating PJI, but the current cure rate for two-stage revision is only 72%-95% according to several studies [7, 11, 13].…”

“…However, with the rapid growth of the population undergoing TKA in recent years, the number of people with PJI has also increased annually [11, 12]. Two-stage revision, involving an antibiotic-impregnated polymethylmethacrylate spacer, is thought to be the gold standard for treating PJI, but the current cure rate for two-stage revision is only 72%-95% according to several studies [7, 11, 13].…”