Reinfection after two-stage revision for periprosthetic infection of total knee arthroplasty

Background. This study evaluates 15 years’ results of the implantation of autoclaved femoral and tibial prosthesis components together with a new same brand polyethylene insert which were used as a temporary articulating spacer in patients with periprosthetic infection of total knee arthroplasty (TKA) in a two-stage reimplantation procedure in 6 patients. Material and methods. The femoral and tibial prostheses of 6 patients with deep chronic periprosthetic infection of TKA who underwent elective two-stage exchange arthroplasty were autoclaved and reinserted with a new polyethylene insert of the same brand and bone cement mixed with tecoplanin in 2004. Results. Four patients were followed for 15 years. They were all female and between 47-70 years old. The infectious agent was meticillin-resistant Staphylococcus aureus (MRSA) in 3 and coagulase negative Staphylococcus in one patient. Patients were invited for second stage reimplantation, but they refused to undergo the second stage. Three of them had their second stage reimplantation after 15, 13 and 10 years while one patient was reinfected after 5 years, in 2009, and arthrodesis was performed. They were all happy with the result and infection free at last follow-up. Conclusions. 1. Regarding the results of our patients, reinsertion of autoclaved femoral and tibial prostheses together with a new same brand polyethylene insert with teicoplanin loaded bone cement can be used cautiously in the management of periprosthetic deep infection of TKA. 2. That is because patients might not want the second stage reimplantation. 3. We believe that the refusal of patients to undergo the surgery shows that the single-stage treatment is effective.

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Corrigendum to “Application of 3D Printing-Assisted Articulating Spacer in Two-Stage Revision Surgery for Periprosthetic Infection after Total Knee Arthroplasty: A Retrospective Observational Study”

BioMed Research International ◽

10.1155/2021/9792626 ◽

2021 ◽

Vol 2021 ◽

pp. 1-1

Author(s):

Lingtong Kong ◽

Jiawei Mei ◽

Wufei Ge ◽

Xiansheng Jin ◽

Xiaoxuan Chen ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

3D Printing ◽

Observational Study ◽

Knee Arthroplasty ◽

Revision Surgery ◽

Periprosthetic Infection ◽

Retrospective Observational Study ◽

Two Stage ◽

Articulating Spacer ◽

Total Knee

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Successful Two-Stage Exchange Arthroplasty for Periprosthetic Infection Following Total Knee Arthroplasty: The Impact of Timing on Eradication of Infection

International Journal of Medical Sciences ◽

10.7150/ijms.47655 ◽

2021 ◽

Vol 18 (4) ◽

pp. 1000-1006

Author(s):

Ines Vielgut ◽

Gerold Schwantzer ◽

Andreas Leithner ◽

Patrick Sadoghi ◽

Uldis Berzins ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Periprosthetic Infection ◽

Two Stage ◽

Exchange Arthroplasty ◽

Eradication Of Infection ◽

Total Knee ◽

The Impact

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Outcomes of single- and two-stage revision total knee arthroplasty for chronic periprosthetic joint infection

The Bone & Joint Journal ◽

10.1302/0301-620x.103b8.bjj-2021-0224.r1 ◽

2021 ◽

Vol 103-B (8) ◽

pp. 1373-1379

Author(s):

Hosam E. Matar ◽

Benjamin V. Bloch ◽

Susan E. Snape ◽

Peter J. James

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Joint Infection ◽

Recurrent Infection ◽

Primary Outcome Measure ◽

Revision Total Knee Arthroplasty ◽

Single Stage ◽

Two Stage ◽

Joint Infections ◽

Total Knee

Aims Single-stage revision total knee arthroplasty (rTKA) is gaining popularity in treating chronic periprosthetic joint infections (PJIs). We have introduced this approach to our clinical practice and sought to evaluate rates of reinfection and re-revision, along with predictors of failure of both single- and two-stage rTKA for chronic PJI. Methods A retrospective comparative cohort study of all rTKAs for chronic PJI between 1 April 2003 and 31 December 2018 was undertaken using prospective databases. Patients with acute infections were excluded; rTKAs were classified as single-stage, stage 1, or stage 2 of two-stage revision. The primary outcome measure was failure to eradicate or recurrent infection. Variables evaluated for failure by regression analysis included age, BMI, American Society of Anesthesiologists grade, infecting organisms, and the presence of a sinus. Patient survivorship was also compared between the groups. Results A total of 292 consecutive first-time rTKAs for chronic PJI were included: 82 single-stage (28.1%); and 210 two-stage (71.9%) revisions. The mean age was 71 years (27 to 90), with 165 females (57.4%), and a mean BMI of 30.9 kg/m2 (20 to 53). Significantly more patients with a known infecting organism were in the single-stage group (93.9% vs 80.47%; p = 0.004). The infecting organism was identified preoperatively in 246 cases (84.2%). At a mean follow-up of 6.3 years (2.0 to 17.6), the failure rate was 6.1% in the single-stage, and 12% in the two-stage groups. All failures occurred within four years of treatment. The presence of a sinus was an independent risk factor for failure (odds ratio (OR) 4.97; 95% confidence interval (CI) 1.593 to 15.505; p = 0.006), as well as age > 80 years (OR 5.962; 95% CI 1.156 to 30.73; p = 0.033). The ten-year patient survivorship rate was 72% in the single-stage group compared with 70.5% in the two-stage group. This difference was not significant (p = 0.517). Conclusion Single-stage rTKA is an effective strategy with a high success rate comparable to two-stage approach in appropriately selected patients. Cite this article: Bone Joint J 2021;103-B(8):1373–1379.

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