Morbid Obesity: A Significant Risk Factor for Failure of Two-Stage Revision Total Knee Arthroplasty for Infection

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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The Use of Spacers in Two-Stage Revision Total Knee Arthroplasty

Journal of the American Academy of Orthopaedic Surgeons ◽

10.5435/jaaos-d-18-00598 ◽

2018 ◽

Vol 26 (23) ◽

pp. e496

Author(s):

Federica Rosso ◽

Davide E. Bonasia ◽

Umberto Cottino ◽

Federico Dettoni ◽

Matteo Bruzzone ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Revision Total Knee Arthroplasty ◽

Two Stage ◽

Total Knee

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Preoperative opioid use is a risk factor for complication and increased healthcare utilization following revision total knee arthroplasty

The Knee ◽

10.1016/j.knee.2020.05.013 ◽

2020 ◽

Vol 27 (4) ◽

pp. 1121-1127

Author(s):

Jacob M. Wilson ◽

Kevin X. Farley ◽

Thomas L. Bradbury ◽

Greg A. Erens ◽

George N. Guild

Keyword(s):

Total Knee Arthroplasty ◽

Risk Factor ◽

Healthcare Utilization ◽

Knee Arthroplasty ◽

Revision Total Knee Arthroplasty ◽

Opioid Use ◽

Total Knee

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Two-stage knee arthrodesis with a modular intramedullary nail due to septic failure of revision total knee arthroplasty with extensor mechanism deficiency

The Knee ◽

10.1016/j.knee.2017.05.019 ◽

2017 ◽

Vol 24 (5) ◽

pp. 1240-1246 ◽

Cited By ~ 10

Author(s):

Max J. Friedrich ◽

Jan Schmolders ◽

Matthias D. Wimmer ◽

Andreas C. Strauss ◽

Milena M. Ploeger ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Intramedullary Nail ◽

Revision Total Knee Arthroplasty ◽

Extensor Mechanism ◽

Knee Arthrodesis ◽

Two Stage ◽

Total Knee

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Custom-made Articulating Spacer in Two-stage Revision Total Knee Arthroplasty. An Early Follow-up of 14 Cases of at Least 1 Year After Surgery

HSS Journal ® ◽

10.1007/s11420-007-9048-1 ◽

2007 ◽

Vol 3 (2) ◽

pp. 159-163 ◽

Cited By ~ 15

Author(s):

Valerio Pascale ◽

Walter Pascale

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Revision Total Knee Arthroplasty ◽

Two Stage ◽

Articulating Spacer ◽

Custom Made ◽

Total Knee

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Long-term result of a second or third two-stage revision total knee arthroplasty for infected total knee arthroplasty

Arthroplasty ◽

10.1186/s42836-020-00062-4 ◽

2021 ◽

Vol 3 (1) ◽

Author(s):

Young-Hoo Kim ◽

Jang-Won Park ◽

Young-Soo Jang

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Recurrent Infection ◽

Revision Total Knee Arthroplasty ◽

Two Stage ◽

Total Knee ◽

The Mean ◽

Revision Tka

Abstract Background Persistent or recurrent infection after two-stage revision total knee arthroplasty (TKA) for the treatment of an infected TKA is a dreaded complication. The purpose of the current study was to determine the ability of a second or third two-stage revision TKA to control infection, evaluate the long-term survivorship of the TKA prosthesis, and measure the functional outcome after a second or third two-stage revision TKA for reinfection. Methods We evaluated 63 patients (65 knees) with failed two-stage TKA treated with a second or a third two-stage revision TKA. There were 25 men and 38 women (mean age, 67 ± 10.2 years). The mean follow-up from the time of a second two-stage TKA revision was 15.1 years (range, 10 to 19 years) and the mean follow-up from the time of a third two-stage TKA revision was 7 years (range, 5 to 10 years). Results Overall, infection was successfully controlled in 49 (78%) of 65 knees after a second two-stage revision TKA was performed. In the remaining 16 knees, recurrent infection was successfully controlled in 12 knees (75%) after a third two-stage revision TKA. Survivorship, free of implant removal for recurrent infection, was 94% at 15.1 years (95% CI, 91 to 100%). Survival free of revision TKA for mechanical failure was 95% (95% CI, 92 to 100%). Conclusions The results of the current study suggest that a second or a third two-stage revision TKA is a reasonable option for controlling infection, relieving pain, and achieving a satisfactory level of function for patients with infected TKAs.

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

The Open Orthopaedics Journal ◽

10.2174/1874325001509010049 ◽

2015 ◽

Vol 9 (1) ◽

pp. 49-56 ◽

Cited By ~ 9

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.

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