scholarly journals Clinical outcomes of two-stage revision total knee arthroplasty in infected cases with antibiotic-loaded cement spacers produced using a handmade silicone mold

2021 ◽  
Vol 33 (1) ◽  
Author(s):  
Takashi Hoshino ◽  
Toshifumi Watanabe ◽  
Yusuke Nakagawa ◽  
Hiroki Katagiri ◽  
Nobutake Ozeki ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Range Of Motion ◽  
Clinical Outcomes ◽  
Knee Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Revision Total Knee Arthroplasty ◽  
Walking Ability ◽  
Total Knee

Abstract Purpose This study assessed the clinical outcomes of periprosthetic joint infection patients who underwent two-stage revision total knee arthroplasty with antibiotic-loaded cement spacers fabricated using a handmade silicone mold. Materials and methods This study included seven patients (average age 77 years, average follow-up time 54 months) who underwent surgery at our hospital between 2009 and 2013. Clinical outcomes including knee scores, function scores, knee range of motion, and walking ability at the final observation, period from the primary total knee arthroplasty to implant removal, period from implant removal to revision total knee arthroplasty, and follow-up period after revision total knee arthroplasty were investigated. Results At the final follow-up, the average knee range of motion was 99°, with no significant differences at each stage; average knee and function scores were 84 and 77, respectively. With cement spacers, five patients were able to walk with a t-cane. No recurrence of infection was observed. Conclusions The clinical outcomes of the current case series demonstrated good knee function with preserved walking ability, without any recurrence of periprosthetic joint infection. This study suggests that using a handmade silicone mold could be an effective option for periprosthetic joint infection after a total knee arthroplasty.

scholarly journals Comparison of Clinical Outcomes Between Total Knee Arthroplasties Using Medial-Pivot and Posterior-Stabilized Prosthesis: Minimum 8-year Follow-up Results in Chinese population

2020 ◽  
Author(s):  
Zheng-yu Gao ◽  
Cui-cui Guo ◽  
Zi-an Zhang ◽  
Guang-qian Shang ◽  
Wei-ning Yan ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Survival Rate ◽  
Range Of Motion ◽  
Clinical Outcomes ◽  
Knee Arthroplasty ◽  
Womac Index ◽  
Prosthesis Survival ◽  
Medial Pivot ◽  
Total Knee

Abstract Objective To compare the clinical outcomes of Medial-pivot and Posterior-stablized total knee arthroplasty during 8 years follow-up. Methods 109 patients with osteoarthritis who underwent primary total knee arthroplasty were conducted and divided into two groups according to the choice of prosthesis,49 in the Medial-pivot(MP) group and 60 in the Postirior-stabilized(PS) group.There were no statistical differences in age,gender,BMI,operative side and operation time between the two groups (P>0.05).The same protocol of perioperative treatment was adopted in both groups. Comparison of clinical outcome and survival rates were acquired through minimum 8 years follow-up. Results The prosthesis survival rate andthe excellent and good rate of MP group were 93.9% and 88.9% during average 8.3 years follow-up period,versus the prosthesis survival rate and the excellent or good rate of PS group were 93.3% and 86.7% during average 8.4 years follow-up period.There were no statistical diferences in survival rate,excellent and good rate and radiolucency of weight-bearing areas between the two groups ( P >0.05). There were no statistical differences in range of motion,KSS score and WOMAC index between the two groups preoperatively (P>0.05).The range of motion at all follow-up time points and KSS score at 6 months postoperatively of PS group were superior than those of MP group ( P <0.05),while the WOMAC index at 8 years postoperatively and Kujala scores at 1year and 8 years postoperatively of PS group were better than those of MP group( P <0.05). Conclusion Either medial-pivot or post-stabilized total knee arthroplasty could obtain excellent or good mid-term clinical result. Although with less range of motion, the patients using MP prosthesis could obtain better results in bone loss, performance of the patellofemoral joint and mid-term satisfaction. However, the use of MP prosthesis required more professional and precise technology and it should be cautious when using for knees with severe valgus deformation.

scholarly journals Two-Stage Revision Total Knee Arthroplasty in Cases of Periprosthetic Joint Infection: An Analysis of 50 Cases

2015 ◽  
Vol 9 (1) ◽  
pp. 49-56 ◽  
Author(s):  
Leif Claassen ◽  
Christian Plaass ◽  
Kiriakos Daniilidis ◽  
Tilman Calliess ◽  
Gabriela von Lewinski
Keyword(s):  
Total Knee Arthroplasty ◽  
Success Rate ◽  
Knee Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Persistent Infection ◽  
Joint Infection ◽  
Revision Total Knee Arthroplasty ◽  
Two Stage ◽  
Comorbidity Index ◽  
Total Knee

Objectives: A periprosthetic joint infection (PJI) is a significant complication after total knee arthroplasty (TKA). Still there is no agreement on a perfect diagnosis and treatment algorithm. The aim of this study was to evaluate the success and revision rates after two-stage revision total knee arthroplasty (TKA) and factors that affect the success rate.Material and Methods:50 consecutive two-stage revision TKAs were performed between January 2011 and December 2012. We retrospectively reviewed study patient's charts including demographics, prior surgeries, comorbidities, incidence of persistent infection and revisions. At the final follow-up examination the patient's satisfaction, pain level and disorders were evaluated. A successful clinical outcome was defined as a functioning prosthesis without wound healing disorders, no sinuses tracts or other clinical evidence of a persistent infection.Results: Re-implantation of prosthesis was performed in 47 cases; three patients received a septic arthrodesis. Twelve patients had a persistent infection despite two-stage re-implantation resulting in a success rate of 76.0%. In eight of these twelve patients an infecting germ was isolated during second-stage procedure. Three patients received another two-stage revision arthroplasty and one patient an above knee amputation. A revision was performed in 23 of 50 patients (46.0%). Factors that diminish the success rate were further operations after primary TKA (p = 0.048), prior revision arthroplasties after TKA (p = 0.045), nicotine abuse (p = 0.048), Charlson comorbidity index above a score of 2 (p = 0.031) and a mixed flora during first-stage procedure (p < 0.001). Age, sex, immune status, chronic anticoagulant use, rheumatoid arthritis, body mass index and the presence of multidrug resistant germs showed no significant effect on success rate (p > 0.05).Conclusion: We found that patients who required surgery after the primary TKA, had a higher Charlson comorbidity index or were found to have mixed flora during explantation. The treatment of PJI remains difficult, both for the patient and for the treating surgeons.

scholarly journals High Rates of Aseptic Loosening After Revision Total Knee Arthroplasty for Periprosthetic Joint Infection

2020 ◽  
Vol 5 (3) ◽  
pp. e20.00026-e20.00026
Author(s):  
Arne Kienzle ◽  
Sandy Walter ◽  
Philipp von Roth ◽  
Michael Fuchs ◽  
Tobias Winkler ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Aseptic Loosening ◽  
Knee Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Revision Total Knee Arthroplasty ◽  
Total Knee

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

Antibiotics ◽  
2021 ◽  
Vol 10 (10) ◽  
pp. 1177
Author(s):  
Lars-Rene Tuecking ◽  
Julia Silligmann ◽  
Peter Savov ◽  
Mohamed Omar ◽  
Henning Windhagen ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Revision Rate ◽  
Joint Infection ◽  
Revision Total Knee Arthroplasty ◽  
Implant Survival ◽  
Two Stage ◽  
Tertiary Center ◽  
Total Knee

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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