Two-stage revision of septic knee prosthesis with articulating knee spacers yields better infection eradication rate than one-stage or two-stage revision with static spacers

Romanò, Carlo Luca; Gala, Luca; Logoluso, Nicola; Romanò, Delia; Drago, Lorenzo

doi:10.1007/s00167-012-1885-x

Cited by 138 publications

(123 citation statements)

References 58 publications

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“…Our results in terms of survivorship free from infection with the single-stage approach appear comparable to those offered by a systematic review of the results of septic TKA revision, which reported mean eradication rates of 90.6% for two-stage and 89.2% for one-stage surgery [32] as well as with other recent studies on the subject of one-stage exchange [36,39,40]. The higher eradication rate after the two-stage revision, especially in combination with a mobile spacer, was based on numerous publications with shortterm followup and/or a low number of study patients with an eradication rate of up to 100%.…”

Section: Discussionsupporting

confidence: 80%

“…Standardized diagnostic and therapeutic algorithms for one-stage exchange have been described to make multicenter studies possible with comparable cohorts [13]. Two-stage revision with mobile or static spacers requires at least two surgeries, a longer period of time with limited mobility in the interval, and more possibility for perioperative complications and morbidity [24,28,32,39].…”

Section: Discussionmentioning

confidence: 99%

“…Although most patients with prosthetic joint infection (PJI) after TKA are treated with a two-stage exchange arthroplasty [15,19,24,27,30,32,35], the one-stage approach has been carried out by certain institutions around the world since the 1970s [8,10,41].…”

Section: Introductionmentioning

confidence: 99%

“…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]. Thus, a direct comparison of success rates with the more often used two-staged approaches cannot be easily drawn, and interpretation of the literature becomes complex [19,32].…”

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: 80%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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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“…Different treatment strategies can be adopted to counteract orthopaedic infections, depending on overall patient conditions (immune system, joint status and its functionality…) and according to involved pathogens and infection severity [6]. In the vast majority of infected total knee arthroplasty (TKA), one-or two-stage exchange is the preferred option to eradicate infection, with success rate ranging from 80 % to 100 % in different studies [7].…”

Section: Introductionmentioning

confidence: 99%

Cementless modular intramedullary nail without bone-on-bone fusion as a salvage procedure in chronically infected total knee prosthesis: long-term results

Scarponi

Drago

Romanò

et al. 2013

International Orthopaedics (SICOT)

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Purpose Our purpose was to evaluate long-term results of two-stage cementless intramedullary nailing without achieving bone-to-bone fusion for treating chronically infected total knee arthroplasty (TKA). Methods Thirty-eight patients treated according to the same protocol were retrospectively evaluated for clinical, functional, laboratory and radiological outcomes. Results Spacer exchange was necessary for infection persistence in one case. At a minimum two year follow-up, 34 patients (89.5 %) showed no infection recurrence; among these 34 patients, 29 (85.3 %) reported no or moderate pain [visual analogue scale (VAS) ≤3]; mild to moderate handicap (Lequesne Algofunctional Index<7.5) was observed in 18 patients (52.9 %). No patient underwent revision for aseptic loosening, and no nail breakage was observed. Conclusions Two-stage cementless intramedullary nailing without achieving bone-to-bone fusion is a viable option for treating chronically infected TKA in selected, complex cases.

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Management of the Infected Total Knee Arthroplasty

Veltman

Moojen

2021

Evidence‐Based Orthopedics

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Two-stage revision of septic knee prosthesis with articulating knee spacers yields better infection eradication rate than one-stage or two-stage revision with static spacers

Abstract: IV.

Cited by 138 publications

References 58 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

Cementless modular intramedullary nail without bone-on-bone fusion as a salvage procedure in chronically infected total knee prosthesis: long-term results

Management of the Infected Total Knee Arthroplasty

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