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 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 External fixator arthrodesis antibiotic spacer in two-stage revision total knee arthroplasty for eradication of periprosthetic joint infection

2019 ◽  
Vol 5 (3) ◽  
pp. 309-313
Author(s):  
Brian P. Chalmers ◽  
Nicholas M. Hernandez ◽  
Brandon J. Yuan ◽  
Matthew P. Abdel ◽  
David G. Lewallen ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
External Fixator ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Revision Total Knee Arthroplasty ◽  
Two Stage ◽  
Total Knee ◽  
Antibiotic Spacer

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.

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.

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