Reference Citation Analysis: Find an Article, Find a Category, Find a Journal, Find a Scholar

For: Romanò CL, Gala L, Logoluso N, Romanò D, Drago L. 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. Knee Surg Sports Traumatol Arthrosc 2012;20:2445-53. [PMID: 22270671 DOI: 10.1007/s00167-012-1885-x] [Citation(s) in RCA: 122] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Accepted: 01/10/2012] [Indexed: 12/12/2022]

For:	Romanò CL, Gala L, Logoluso N, Romanò D, Drago L. 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. Knee Surg Sports Traumatol Arthrosc 2012;20:2445-53. [PMID: 22270671 DOI: 10.1007/s00167-012-1885-x] [Citation(s) in RCA: 122] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Accepted: 01/10/2012] [Indexed: 12/12/2022]

Number

Cited by Other Article(s)

Dilger OB, Owen AR, Bedard NA, Mabry TM, Berry DJ, Abdel MP. Repeat Two-Stage Exchange Arthroplasty for Recurrent Periprosthetic Knee Infection: Results of 87 Cases. J Arthroplasty 2025:S0883-5403(25)00217-7. [PMID: 40089122 DOI: 10.1016/j.arth.2025.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2024] [Revised: 03/04/2025] [Accepted: 03/05/2025] [Indexed: 03/17/2025] Open

Abstract

BACKGROUND

Despite the success of two-stage exchange total knee arthroplasties (TKAs), a subset of patients become reinfected and may be considered for a repeat two-stage exchange TKAs. A small, prior study from our institution demonstrated a 50% re-revision rate in such a cohort. The purpose of the present study was to evaluate a contemporary and larger cohort of repeat two-stage exchange TKAs with an emphasis on implant survivorship, risk factors, and clinical outcomes.

METHODS

We retrospectively identified 87 repeat two-stage exchange TKAs performed between 2014 and 2021. The mean patient age was 66 years, 32% were women, and the mean body mass index was 29. At the time of resection, 98% of patients were treated with a high-dose antibiotic spacer (58 nonarticulating and 27 articulating). The mean time from resection arthroplasty to reimplantation was 22 weeks. Kaplan-Meier survivorship analyses were performed, and risk factors (including the McPherson staging system) were assessed. The mean follow-up was five years (range, two to nine).

RESULTS

The 5-year survivorships free of rerevision for reinfection, any rerevision, and any reoperation were 88, 67, and 54%, respectively. Leading causes for rerevision were periprosthetic joint infection (36%) and aseptic loosening (27%). There were no statistically significant independent risk factors identified. However, patients who had McPherson host grade C trended toward higher rates of reoperation (hazard ratio: 2, P = 0.057). Despite the high reoperation rate, at the final follow-up (mean five years), 91% of patients had a TKA in situ, 8% had been treated with above-knee amputation, and 1% with a definitive resection arthroplasty.

CONCLUSIONS

Despite its challenges, including a 54% reoperation rate, repeat two-stage exchange TKAs may be considered in a subset of patients given 91% of patients had a TKA in situ at a mean of five years, and the 5-year survivorship free of rerevision for infection was 88%. Notably, patients who were McPherson host grade C trended toward failure.

LEVEL OF EVIDENCE

Level IV.

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Alt V, Szymski D, Rupp M, Fontalis A, Vaznaisiene D, Marais LC, Wagner C, Walter N. The health-economic burden of hip and knee periprosthetic joint infections in Europe : a comprehensive analysis following primary arthroplasty. Bone Jt Open 2025;6:298-311. [PMID: 40054494 PMCID: PMC11888791 DOI: 10.1302/2633-1462.63.bjo-2024-0225.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/03/2025] Open

Abstract

Aims

Periprosthetic joint infections (PJIs) pose significant challenges to patients and healthcare systems worldwide. The aim of this study was to estimate the health-economic burden of reimbursement payment in Europe for PJIs following primary hip and knee arthroplasty.

Methods

The calculation was based on health-economic modelling using data on primary hip and knee arthroplasties for the year 2019 from the Statistical Office of the European Union (Eurostat) and published infection rates to estimate the total number of hip and knee PJIs in 30 European countries. Revision procedures were stratified into: 1) debridement, antibiotics, and implant retention (DAIR); 2) one-stage exchange; and 3) two-stage revision procedures. The cases were then multiplied by the respective healthcare system reimbursement payments. Payment data were acquired from a survey of 13 countries (Austria, Croatia, France, Germany, Italy, Lithuania, Netherlands, Norway, Portugal, Slovenia, Switzerland, Turkey, and the UK) and extrapolated for the remaining countries.

Results

In 2019, a total of 2,048,778 primary total joint replacements were performed (total hip arthroplasty (THA) = 1,147,316 and total knee arthroplasty (TKA) = 901,462), with an estimated 20,416 cases of PJIs (11,131 hip and 9,285 knee) in Europe. This results in an estimated total reimbursement burden of €346,262,026 for European healthcare systems. The breakdown for hip PJI reimbursement was €197,230,953 (€9,751,962 for DAIR procedures, €45,135,894 for one-stage revisions, and €142,343,097 for two-stage revisions). For knee PJIs, the analysis yielded a total reimbursement of €149,031,073 (€9,335,075 for DAIR procedures, €48,058,479 for one-stage revisions, and €91,637,518 for two-stage revisions).

Conclusion

This is the first study to evaluate the health-economic burden of PJIs in Europe, revealing a substantial impact on healthcare systems with an estimated case load of 20,414 cases and overall reimbursement of €346,262,026 for primary THAs and TKAs performed in 2019.

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Pioger C, Marmor S, Bouché PA, Kerroumi Y, Lhotellier L, Graff W, Mouton A, Heym B, Zeller V. One-stage exchange strategy with extensive debridement for chronic periprosthetic joint infection following total knee arthroplasty is associated with a low relapse rate in non-selected patients: a prospective single-center analysis. Orthop Traumatol Surg Res 2025;111:104019. [PMID: 39393489 DOI: 10.1016/j.otsr.2024.104019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 08/05/2024] [Accepted: 10/08/2024] [Indexed: 10/13/2024]

Abstract

PURPOSE

This prospective clinical cohort was undertaken to determine the long-term risks of reinfection and all-cause aseptic failure after 1-stage exchange total knee arthroplasties (TKA) in a large series of consecutive patients with periprosthetic joint infection (PJI) following TKA.

HYPOTHESIS

One-stage exchange for chronic PJI is an effective strategy, even in a non-selected population.

PATIENTS AND METHODS

Non-selected patients (152 with 154 PJI) undergoing 1-stage-exchange TKA for PJI (January 2003-August 2015) were prospectively included and monitored for ≥2 years. PJI following TKA satisfying Musculoskeletal Infection Society diagnostic criteria were documented by microbiological culture results of preoperative joint aspirates and/or intraoperative samples. The cumulative incidences of total reinfections (i.e., relapses or new infections) and aseptic revisions were assessed. The mean follow-up (FU) duration was 7.5 years post-reimplantation.

RESULTS

At the last follow-up, 35 knees had developed reinfections: 7 relapses and 28 new infections, with respective 14-year cumulative incidences of 4.8% and 20.6%. The 2-, 5- and 14-year cumulative total reinfection incidences were 12.3%, 21.3% and 24.3%, respectively. Respective 2-, 5-, 10- and 14-year aseptic component-revision incidences were 0.7%, 3.2%, 5.4% and 13.4%. Multivariate analysis retained male sex (HR 3.27, p < 0.01) and preoperative atrial fibrillation (HR 3.03; p = 0.01) as being significantly associated with greater risk of reinfection.

CONCLUSIONS

One-stage-exchange TKA with aggressive debridement for chronic PJI is apparently a valid strategy, even for non-selected patients. It was associated with a low relapse rate, prevented morbidity and avoided economic social costs of 2-stage exchange. New infections with a different microorganism were observed more frequently and occurred even after years of FU.

LEVEL OF EVIDENCE

II; Therapeutic.

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Hoveidaei AH, Ghaseminejad-Raeini A, Jebeli-Fard R, Hosseini-Asl SH, Luo TD, Sandiford NA, Adolf J, Citak M. Does the duration of antibiotic treatment following one-stage treatment of infected total knee arthroplasty influence the eradication rate? A systematic review. Arch Orthop Trauma Surg 2024;145:53. [PMID: 39680211 DOI: 10.1007/s00402-024-05691-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 10/07/2024] [Indexed: 12/17/2024]

Abstract

PURPOSE

The aim of this study was to perform a systematic review of the current literature to elucidate the optimal duration of systemic antibiotic therapy following one-stage revision TKA in the setting of PJI.

METHODS

We conducted an electronic search in four databases including Medline (PubMed), Scopus, Web of Science, and Cochrane Central Register of Controlled Trials without any publication date, language or study design filter on October 1, 2022. The search strategy adhered to PRISMA guidelines and consisted of four main keywords categories which were knee arthroplasty or knee prosthesis, infection and one-stage/single-stage revision. Duration of antibiotic administration were classified to three groups: short-term IV therapy (≤ two weeks), short-term IV therapy plus oral therapy, and long-term IV therapy (minimum six weeks).

RESULTS

We identified 963 studies, of which 21 were included in the systematic review. Coagulase-negative Staphylococcal species were the most frequently isolated pathogens. The mean eradication rate for all the studies analyzed was 88.4% (range, 62.5-100%). Short-term IV + long-term oral antibiotic therapy demonstrated significantly higher eradication rate compared to the other two regimens following one-stage revision TKA (p = 0.023) (Table 4). In the ten studies with great than five years of follow-up, this difference was no longer statistically significant. Subgroup analysis of antibiotic-loaded cement (ABLC) usage demonstrated higher eradication rates with short-term IV + long-term oral (92.8%) and long-term IV antibiotics (89.7%) compared to short-term IV antibiotics alone (p = 0.006).

CONCLUSION

We demonstrated that short-term IV antibiotics followed by oral antibiotics had similar eradication rates to long-term IV antibiotics in long-term studies, which were both superior to short-term IV antibiotics alone. Nevertheless, there remains a need for prospective and randomized studies to further elucidate a patient-based protocol for the type and duration of antibiotic use following one-stage PJI treatment of the knee.

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Sutton R, Lizcano JD, Fraval A, Wiafe B, Courtney PM, Brown S. Comparable Results of Single and Two-Stage Exchange for Select Periprosthetic Hip and Knee Infection. J Am Acad Orthop Surg 2024;32:e1308-e1314. [PMID: 38833728 DOI: 10.5435/jaaos-d-24-00013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 04/26/2024] [Indexed: 06/06/2024] Open

Abstract

INTRODUCTION

Although two-stage exchange has been the standard of care for periprosthetic joint infection (PJI) in the United States, single-stage exchange is emerging as an option in select patients. The purpose of this study was to compare outcomes of patients undergoing single-stage and two-stage exchange using strict surgical indications.

METHODS

We reviewed a consecutive series of 196 patients with diagnosed PJI undergoing revision total knee and hip arthroplasty from 2017 to 2021. Patients were excluded if they had PJI history, plastic surgery coverage, or extensive bone loss requiring endoprosthesis. We compared the number of patients PJI-free at 1-year follow-up using MusculoSkeletal Infection Society criteria and patients requiring re-revision between the single-stage and two-stage groups.

RESULTS

In total, 126 patients met inclusion criteria. Of 61 knee patients (48.4%), 22 underwent single-stage (36%) and 39 underwent two-stage (63.9%). Of 65 hip patients (51.6%), 38 underwent single-stage (58.5%) and 27 underwent two-stage (41.5%). At a mean follow-up of 1.95 ± 0.88 years, a higher rate of knee patients were classified as having treatment success in the single-stage group (77.3% versus 69.2%, P = 0.501), however with comparable septic failure rates (18.1% single-stage versus 17.9% two-stage; P = 0.982). At a mean follow-up of 1.81 ± 0.9 years, a higher rate of hip patients were classified as having treatment success in the single-stage group (94.7% versus 81.5%, P = 0.089), and more patients had septic failures in the two-stage group (18.5% versus 5.3%; P = 0.089). No differences were observed in the microorganism profile. More total complications ( P = 0.021) and mortalities were found in the single-stage knee cohort than in the two-stage cohort (22.7% versus 2.6%; P = 0.011).

CONCLUSION

Single-stage arthroplasty is a viable alternative to standard two-stage exchange in patients with PJI without a history of infection and with no bone or soft-tissue compromise. Additional studies with longer term follow-up are needed to evaluate its efficacy.

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Suliman J, Warda H, Samaan M. Review of recent advances in the diagnosis and management of periprosthetic joint infection after total knee arthroplasty part 2: single-stage or two-stage surgical technique? J Orthop Surg Res 2024;19:643. [PMID: 39395987 PMCID: PMC11470652 DOI: 10.1186/s13018-024-05152-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Accepted: 10/05/2024] [Indexed: 10/14/2024] Open

Abstract

Periprosthetic joint infection (PJI) after total knee arthroplasty is a complication that affects approximately 2-3% of patients. The management of this issue is complicated and expensive for both the patients and the healthcare system. Multiple management options are available including antibiotic suppressive therapy, surgical management, and salvage procedures. Surgical management is considered a popular option for treating PJI, with multiple available surgical techniques, including single-stage revision arthroplasty and two-stage revision arthroplasty among others. Two-stage revision has been considered the gold standard for treating PJI. This method consists of two surgical procedures with a time interval in between, the first procedure aims to eradicate the infection along with implanting either a static or a mobile spacer, while the second intervention aims to remove the spacer and implant a new prothesis. During the interval period the patient is closely monitored through a handful of laboratory tests and clinical signs that help in assessing the optimal time of undertaking the second stage. However, in recent years, the single-stage method has gained much attention for its comparable outcomes and fewer complications. Contrary to the two-stage method, the single-stage approach consists only of one procedure in which the old infected prosthesis is removed and a new one is implanted. Many articles have compared the two methods over the years but have not agreed on a particular approach to be more potent in eliminating infection and providing better outcomes. Plenty of questions are yet to be answered regarding the two methods, including the superior type of spacer, interim period duration, and single-stage revision inclusion criteria. We herein, aim to address these issues, highlighting recent advances in managing this morbid complication and discussing controversial topics in the staged procedures.

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Park KB, Kim JM, Lee BS, Kim MS, Park JH. Clinical outcomes of two-stage revision arthroplasty using a spiked tibial cement spacer in infected total knee arthroplasty. INTERNATIONAL ORTHOPAEDICS 2024;48:2617-2623. [PMID: 39066904 PMCID: PMC11422480 DOI: 10.1007/s00264-024-06257-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 07/12/2024] [Indexed: 07/30/2024]

Abstract

PURPOSE

A tibial cement spacer (TCS) with spikes offers better initial stability than a conventional TCS and reduces spacer-related problems in two-stage revision total knee arthroplasty (R-TKA) for infection. We compared the clinical outcomes of two-stage revision arthroplasty for infected TKA using spiked TCS with that of conventional TCS.

METHODS

This retrospective cohort study included 29 patients who underwent two-stage revision arthroplasty using an articulating cement spacer and who could be followed up for at least one year. Group S comprised 14 patients using spiked TCS, whereas Group C comprised 15 patients using conventional TCS. Demographic data, the interval from first to second stage revision, motion arc, numerical rating scale (NRS), Knee Society (KS) score, serum levels of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), and frequency of repeating the first-stage and infection recurrence after R-TKA between the groups were analyzed.

RESULTS

No significant differences were observed in the female ratio and mean age between both groups. The mean interval between the first and second stage revision was significantly shorter in Group S than in Group C. The mean motion arc was significantly larger in Group S than in Group C. The mean NRS was significantly lower in Group S than in Group C. The mean KS score in Group S was significantly higher than that in Group C. Serum ESR and CRP levels did not differ between the groups. The frequency of repeating the first stage was lower in Group S than in Group C. However, the recurrence rate after R-TKA was higher in Group S than in Group C.

CONCLUSION

Compared with conventional TCS, spiked TCS shortened the period until R-TKA and improved pain and function levels. However, no significant difference existed in the rate of infection recurrence after R-TKA.

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Naoum S, Koutserimpas C, Pantekidis I, Giovanoulis V, Veizi E, Piagkou M, Ioannou P, Samonis G, Domouchtsidou A, Tsantes AG, Papadopoulos DV. Antimicrobial Regimens in Cement Spacers for Periprosthetic Joint Infections: A Critical Review. Antibiotics (Basel) 2024;13:772. [PMID: 39200072 PMCID: PMC11351621 DOI: 10.3390/antibiotics13080772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Revised: 08/11/2024] [Accepted: 08/13/2024] [Indexed: 09/01/2024] Open

Affiliation(s)

Symeon Naoum Department of Trauma and Orthopaedics, Royal Berkshire Hospital, Reading RG1 5AN, UK;
Christos Koutserimpas Orthopaedic Surgery and Sports Medicine Department, Croix-Rousse Hospital, University Hospital, 69317 Lyon, France Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, 75 Mikras Asias Str., Goudi, 11527 Athens, Greece;
Ioannis Pantekidis Department of Trauma and Orthopaedics, Guy’s and St. Thomas’ NHS Foundation Trust, London SE1 7EH, UK
Vasileios Giovanoulis Department of Orthopaedic Surgery, Hôpital Henri Mondor, AP-HP, Université Paris Est Créteil (UPEC), 94010 Creteil, France;
Enejd Veizi Department of Orthopedics and Traumatology, Yıldırım Beyazıt University, Ankara City Hospital, Ankara 2367, Turkey;
Maria Piagkou Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, 75 Mikras Asias Str., Goudi, 11527 Athens, Greece;
Petros Ioannou School of Medicine, University of Crete, 71003 Heraklion, Greece (G.S.)
George Samonis School of Medicine, University of Crete, 71003 Heraklion, Greece (G.S.) First Department of Medical Oncology, Metropolitan Hospital of Neon Faliron, 18547 Athens, Greece
Aglaia Domouchtsidou Microbiology Department, “Saint Savvas” Oncology Hospital, 11522 Athens, Greece; (A.D.); (A.G.T.)
Andreas G. Tsantes Microbiology Department, “Saint Savvas” Oncology Hospital, 11522 Athens, Greece; (A.D.); (A.G.T.) Laboratory of Hematology and Blood Bank Unit, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
Dimitrios V. Papadopoulos 2nd Academic Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, 14233 Athens, Greece;

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Jankowski JM, Menken LG, Romanelli F, Hong IS, Tang A, Yoon RS, Liporace FA. Outcomes of Antibiotic-Impregnated Calcium Sulfate, Reamer-Irrigator-Aspirator, and Locked Intramedullary Static Spacer in the Treatment of Periprosthetic Joint Infection in the Multiply Revised and Infected Knee: A Single-Center Case Series. Arthroplast Today 2024;27:101370. [PMID: 38690098 PMCID: PMC11058074 DOI: 10.1016/j.artd.2024.101370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 02/13/2024] [Accepted: 02/28/2024] [Indexed: 05/02/2024] Open

Abstract

Background

Periprosthetic joint infection after total knee arthroplasty is commonly treated via 2-stage revision utilizing either articulating or static antibiotic cement spacers. While recent literature exhibits a slight functional advantage in favor of articulating spacers, those patients with a history of recurrent infection/multiple revision procedures are frequently excluded from these studies. The purpose of this study was to report infection eradication rates and efficacy of utilizing antibiotic-loaded locked intramedullary nail for infection for the multiply revised, infected total knee arthroplasty.

Methods

A retrospective review was performed of all consecutive patients receiving static spacers between 2017 and 2020 at an academic medical center. Surgical techniques for all patients included irrigation and debridement using a reamer-irrigator-aspirator, injection of antibiotic-loaded calcium sulfate into the intramedullary canal, and nail placement. Antibiotic-loaded cement is then used to create a spacer block in the joint space. A Cox proportional hazard regression was run to identify risk factors for reinfection.

Results

Forty-two knees in 39 patients were identified meeting inclusion criteria. Overall, there was an 68.8% infection eradication rate at an average of 46.9 months following spacer placement. The only risk factors identified on cox regression were increasing number of previous spacers, a surrogate for previous infections (hazards ratio = 14.818, P value = .021), and increasing operative time during spacer placement (hazards ratio = 1.014, P value = .039).

Conclusions

Use of static spacers, in conjunction with reamer-irrigator-aspirator and antibiotic-loaded calcium sulfate, can be effective in treating chronic, complex periprosthetic joint infections in the setting of bone loss and or soft-tissue compromise and produced similar results to more simple infection scenarios.

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Affiliation(s)

Jaclyn M. Jankowski Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center – RWJBarnabas Health, Livingston, NJ, USA Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center – RWJBarnabas Health, Jersey City, NJ, USA
Luke G. Menken Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center – RWJBarnabas Health, Livingston, NJ, USA Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center – RWJBarnabas Health, Jersey City, NJ, USA
Filippo Romanelli Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center – RWJBarnabas Health, Livingston, NJ, USA Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center – RWJBarnabas Health, Jersey City, NJ, USA
Ian S. Hong Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center – RWJBarnabas Health, Livingston, NJ, USA Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center – RWJBarnabas Health, Jersey City, NJ, USA
Alex Tang Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center – RWJBarnabas Health, Livingston, NJ, USA Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center – RWJBarnabas Health, Jersey City, NJ, USA
Richard S. Yoon Corresponding author. Orthopaedic Research, Jersey City Medical Center – RWJBarnabas Health, 377 Jersey Avenue, Suite 550, Jersey City, NJ 07302, USA. Tel.: +1 201 716 5850.
Frank A. Liporace Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center – RWJBarnabas Health, Livingston, NJ, USA Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center – RWJBarnabas Health, Jersey City, NJ, USA

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Shao H, Zhou Y. Management of soft tissues in patients with periprosthetic joint infection. ARTHROPLASTY 2023;5:52. [PMID: 37784182 PMCID: PMC10546773 DOI: 10.1186/s42836-023-00205-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 07/31/2023] [Indexed: 10/04/2023] Open

Roof MA, Aggarwal VK, Schwarzkopf R. The Economics of Revision Arthroplasty for Periprosthetic Joint Infection. Arthroplast Today 2023;23:101213. [PMID: 37745961 PMCID: PMC10511334 DOI: 10.1016/j.artd.2023.101213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 09/26/2023] Open

Rodriguez J, Perez Alamino L, Garabano G, Taleb JP, Del Sel H, Pesciallo C. Two-Stage Treatment of Chronic Periprosthetic Knee Infections With the Use of Gentamicin-Articulated Spacers: Success Rate and Predictors of Failure at the Minimum Seven-Year Follow-Up. Arthroplast Today 2023;23:101177. [PMID: 37712075 PMCID: PMC10498403 DOI: 10.1016/j.artd.2023.101177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 06/20/2023] [Accepted: 07/01/2023] [Indexed: 09/16/2023] Open

Janssen DMC, Willems P, Geurts J, Arts CJJ. Antibiotic release from PMMA spacers and PMMA beads measured with ELISA: Assessment of in vitro samples and drain fluid samples of patients. J Orthop Res 2023;41:1831-1839. [PMID: 36597743 DOI: 10.1002/jor.25510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/30/2022] [Accepted: 12/21/2022] [Indexed: 01/05/2023]

Kinder KD, Apple AE, Barnes CL, Stronach BM, Mears SC, Stambough JB. Articulating Knee Spacers in the Treatment of Periprosthetic Joint Infection: All Polyethylene Tibia or Tibial Insert? J Arthroplasty 2023;38:1145-1150. [PMID: 36878440 PMCID: PMC10200764 DOI: 10.1016/j.arth.2023.02.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/24/2023] [Accepted: 02/27/2023] [Indexed: 03/08/2023] Open

Abstract

BACKGROUND

The best antibiotic spacer for periprosthetic knee joint infection treatment is unknown. Using a metal-on-polyethylene (MoP) component provides a functional knee and may avoid a second surgery. Our study investigated complication rates, treatment efficacies, durabilities, and costs of MoP articulating spacer constructs using either an all-polyethylene tibia (APT) or a polyethylene insert (PI). We hypothesized that while the PI would cost less, the APT spacer would have lower complication rates and higher efficacies and durabilities.

METHODS

A retrospective review evaluated 126 consecutive articulating knee spacer (64 APTs and 62 PIs) cases from 2016 to 2020 was performed. Demographic information, spacer components, complication rates, infection recurrence, spacer longevity, and implant costs were analyzed. Complications were classified as follows: spacer-related; antibiotic-related; infection recurrence; or medical. Spacer longevity was measured for patients who underwent reimplantation and for those who had a retained spacer.

RESULTS

There were no significant differences in overall complications (P < .48), spacer-related complications (P = 1.0), infection recurrences (P = 1.0), antibiotic-related complications (P < .24), or medical complications (P < .41). Average time to reimplantation was 19.1 weeks (4.3 to 98.3 weeks) for APT spacers and 14.4 weeks (6.7 to 39.7 weeks) for PI spacers (P = .09). There were 31% (20 of 64) of APT spacers and 30% (19 of 62) of PI spacers that remained intact for an average duration of 26.2 (2.3 to 76.1) and 17.1 weeks (1.7 to 54.7) (P = .25), respectively, for patients who lived for the duration of the study. PI spacers cost less than APT ($1,474.19 versus $2,330.47, respectively; P < .0001).

CONCLUSION

APT and PI tibial components have similar results regarding complication profiles and infection recurrence. Both may be durable if spacer retention is elected, with PI constructs being less expensive.

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Oladipo V, Tseng J, Sporer S, Levine B. Modern Description of Antibiotic Spacer Options for PJI in Revision Total Knee Arthroplasty: Clinical Outcomes and Infection Eradication Rates. J Arthroplasty 2023;38:S318-S325. [PMID: 36996946 DOI: 10.1016/j.arth.2023.03.061] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 03/20/2023] [Accepted: 03/21/2023] [Indexed: 04/01/2023] Open

Ciccullo C, Neri T, Farinelli L, Gigante A, Philippot R, Farizon F, Boyer B. Antibiotic Prophylaxis in One-Stage Revision of Septic Total Knee Arthroplasty: A Scoping Review. Antibiotics (Basel) 2023;12:606. [PMID: 36978473 PMCID: PMC10044675 DOI: 10.3390/antibiotics12030606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 02/28/2023] [Accepted: 03/15/2023] [Indexed: 03/30/2023] Open

Klemt C, Padmanabha A, Esposito JG, Laurencin S, Smith EJ, Kwon YM. Elevated ESR and CRP Prior to Second-Stage Reimplantation Knee Revision Surgery for Periprosthetic Joint Infection Are Associated with Increased Reinfection Rates. J Knee Surg 2023;36:354-361. [PMID: 34375998 DOI: 10.1055/s-0041-1733902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]

Abstract

Although two-stage revision surgery is considered as the most effective treatment for managing chronic periprosthetic joint infection (PJI), there is no current consensus on the predictors of optimal timing to second-stage reimplantation. This study aimed to compare clinical outcomes between patients with elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) prior to second-stage reimplantation and those with normalized ESR and CRP prior to second-stage reimplantation. We retrospectively reviewed 198 patients treated with two-stage revision total knee arthroplasty for chronic PJI. Cohorts included patients with: (1) normal level of serum ESR and CRP (n = 96) and (2) elevated level of serum ESR and CRP prior to second-stage reimplantation (n = 102). Outcomes including reinfection rates and readmission rates were compared between both cohorts. At a mean follow-up of 4.4 years (2.8-6.5 years), the elevated ESR and CRP cohort demonstrated significantly higher reinfection rates compared with patients with normalized ESR and CRP prior to second-stage reimplantation (33.3% vs. 14.5%, p < 0.01). Patients with both elevated ESR and CRP demonstrated significantly higher reinfection rates, when compared with patients with elevated ESR and normalized CRP (33.3% vs. 27.6%, p = 0.02) as well as normalized ESR and elevated CRP (33.3% vs. 26.3%, p < 0.01). This study demonstrates that elevated serum ESR and/or CRP levels prior to reimplantation in two-stage knee revision surgery for chronic PJI are associated with increased reinfection rate after surgery. Elevation of both ESR and CRP were associated with a higher risk of reinfection compared with elevation of either ESR or CRP, suggesting the potential benefits of normalizing ESR and CRP prior to reimplantation in treatment of chronic PJI.

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Savvidis I, Rigkos D, Solovos E, Georgiannos D, Bisbinas I. Above-Knee Amputation After Total Knee Replacement Infection: The Unfortunate End of an Odyssey. Cureus 2023;15:e35052. [PMID: 36942169 PMCID: PMC10024461 DOI: 10.7759/cureus.35052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2023] [Indexed: 02/18/2023] Open

Rajgor H, Dong H, Nandra R, Parry M, Stevenson J, Jeys L. Repeat revision TKR for failed management of peri-prosthetic infection has long-term success but often require multiple operations: a case control study. Arch Orthop Trauma Surg 2023;143:987-994. [PMID: 35980459 DOI: 10.1007/s00402-022-04594-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 08/10/2022] [Indexed: 11/25/2022]

Abstract

BACKGROUND

Prosthetic joint infection (PJI) is associated with poor outcomes and catastrophic complications. The aim of this study was to present the outcomes of re-revision surgery for PJI of the knee following previous failed two-stage exchange arthroplasty.

MATERIALS AND METHODS

A retrospective analysis was performed of 32 patients who underwent re-revision knee arthroplasty, having already undergone at least one previous two-stage exchange for PJI with a minimum follow-up of two-years for alive patients. Outcomes were compared to a matched control of two-stage revisions for PJI of a primary knee replacement also containing 32 patients. Outcomes investigated were eradication of infection, re-operation, mortality and limb-salvage rate.

RESULTS

Successful eradication of infection was achieved in 50% of patients following re-revision surgery, compared with 91% following two-stage exchange of primary knee replacement for PJI (p < 0.001). Fourteen (44%) patients required further re-operation compared with three (9%) patients in the primary group (p = 0.006). Amputation was performed in one case (3%) with thirteen patients (92%) who had infection controlled by debridement, antibiotics and implant retention (DAIR), further revision surgery or arthrodesis. Two patients died with infection (6%) and the long-term rate for infection control was 91%. The mean number of procedures following surgery for the re-revision group was 2.8 (0-9) compared with 0.13 (0-1) for the primary two-stage group (p < 0.001). Five-year patient survival was 90.6% (95% CI 77.1-100). The limb-salvage rate for the re-revision cohort was 97%.

CONCLUSION

Outcomes for re-revision knee arthroplasty for PJI have higher re-operation and failure rates, but no worse mortality than in revisions of primary knee replacements. Failures can successfully be managed by further operation.

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Wignadasan W, Ibrahim M, Haddad FS. One- or two-stage reimplantation for infected total knee prosthesis? Orthop Traumatol Surg Res 2023;109:103453. [PMID: 36302451 DOI: 10.1016/j.otsr.2022.103453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/08/2022] [Accepted: 03/02/2022] [Indexed: 11/07/2022]

Mohamed NS, Castrodad IMD, Etcheson JI, Kelemen MN, Plate FJ, Conway JD, Delanois RE. Treatment of Periprosthetic Joint Infection in Total Knee Arthroplasty with a Temporary Intramedullary Nail: Is a Long or Short Nail Better? J Knee Surg 2023;36:39-46. [PMID: 33946115 DOI: 10.1055/s-0041-1729552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]

Abstract

To our knowledge, no studies have compared postoperative outcomes between patients who received a temporary short or long intramedullary (IM) nail in the setting of infected total knee arthroplasty (TKA). Therefore, the aim of this study was to compare short-term outcomes for patients who underwent long or short IM nail insertion for treatment of periprosthetic knee infection. Specifically, we compared: (1) success rates; (2) patient reported/functional outcomes; and (3) complications between patients implanted with a short or a long IM nail following PJI of the knee. A retrospective chart review was performed for patients who underwent two-stage exchange arthroplasty with a temporary long or short IM nail between November 2010 and June 2018 at our institution (n = 67). Continuous and categorical variables were assessed using t-test/Mann-Whitney U test and chi-squared test, respectively. Logistic regression analyses were conducted to assess the effect of IM nail length on success rate while adjusting for age, sex, body mass index, and race. A total of 36 patients underwent temporary treatment with a long IM nail, while 31 patients received a short IM nail. There were no differences in success rate for reimplanted patients treated with long and short IM nails (odds ratio 0.992; p = 0.847). Fewer patients with a long IM nail went on to reimplantation (52.8 vs. 83.9%; p = 0.007). There was no difference in satisfaction (7.86 vs. 7.68; p = 0.515), pain scores (3.39 vs. 4.45 points; p = 0.126), or Knee Society score outcome scores (150.61 vs. 166.26 points; p = 0.117) between long or short IM nail patients. Following reimplantation, there was no difference in the number of patients who became reinfected (15.8 vs. 11.5%; p = 0.679) or went on to amputation (0 vs. 7.7%; p = 0.210). Periprosthetic joint infection (PJI) is a rare but serious postoperative complication following TKA. Our findings suggest that the use of long and short IM nails during two-stage exchange can have equal utility in PJI patients with severe bone defects.

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Qiao YJ, Li F, Zhang LD, Yu XY, Zhang HQ, Yang WB, Song XY, Xu RL, Zhou SH. Analysis of the clinical efficacy of two-stage revision surgery in the treatment of periprosthetic joint infection in the knee: A retrospective study. World J Clin Cases 2022;10:13239-13249. [PMID: 36683646 PMCID: PMC9851019 DOI: 10.12998/wjcc.v10.i36.13239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/15/2022] [Accepted: 12/05/2022] [Indexed: 12/26/2022] Open

Vasso M, Capasso L, Corona K, Pola E, Toro G, Schiavone Panni A. Periprosthetic knee infection: treatment options. Orthop Rev (Pavia) 2022;14:37537. [PMID: 36349351 PMCID: PMC9635989 DOI: 10.52965/001c.37537] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/26/2024] Open

Walter N, Baertl S, Lang S, Szymski D, Weber J, Alt V, Rupp M. Treatment of Periprosthetic Joint Infection and Fracture-Related Infection With a Temporary Arthrodesis Made by PMMA-Coated Intramedullary Nails – Evaluation of Technique and Quality of Life in Implant-Free Interval. Front Surg 2022;9:917696. [PMID: 36117826 PMCID: PMC9478367 DOI: 10.3389/fsurg.2022.917696] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/13/2022] [Indexed: 11/16/2022] Open

Abstract

Background

Antimicrobial coating of intramedullary nails with polymethyl methacrylate (PMMA) bone cement promises infection control and stabilization for subsequent bone healing. However, when removing the implant, bone cement can debond and remain in the medullary cavity of the long bones, representing a nidus for reinfection. This work presents a technique comprising reinforcement of PMMA-coated intramedullary nails with cerclage wire to prevent such problems in patients treated for fracture-related infection (FRI) or knee periprosthetic joint infection (PJI) with a static spacer as temporary arthrodesis allowing weight-bearing in the implant-free interval. Outcomes of this surgical treatment were evaluated in terms of (i) associated complications and (ii) patient-reported quality of life.

Methods

In this retrospective case series, 20 patients with PJI (n = 14, 70%) and FRI (n = 6, 30%) treated with PMMA-coated intramedullary nails reinforced with cerclage wire between January 2021 and July 2021 were included. Quality of life during the implant-free interval was evaluated with the EQ-5D, SF-36, and an ICD-10 based psychological symptom rating and compared with previously analyzed cohorts of successfully treated PJI and FRI patients in whom eradication of infection and stable bone consolidation was achieved.

Results

Complications during the implant-free interval comprised a broken nail in one case (5.0%) and a reinfection in one case (5.0%). Coating-specific side effects and cement debonding during removal did not occur. The mean physical health component score of SF-36 was 26.1 ± 7.6, and the mean mental health component score reached a value of 47.1 ± 18.6. The mean EQ-5D index value was 0.36 ± 0.32 and the mean EQ-5D visual analogue scale rating was 47.4 ± 19.4. The scores were significantly lower than those in the successfully treated FRI cohort but not in the PJI cohort. The mean ICD-10-based symptom rating scores revealed psychological symptom burden on the depression scale and enhanced levels of anxiety in comparison with healed FRI and PJI patients.

Conclusion

Reinforcement of PMMA bone cement-coated implants seems to be a reasonable treatment option to create a temporary arthrodesis, preventing detachment of the bone cement when the implant was removed.

Level of Evidence: IV.

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Are Static Spacers Superior to Articulated Spacers in the Staged Treatment of Infected Primary Knee Arthroplasty? A Systematic Review and Meta-Analysis. J Clin Med 2022;11:jcm11164854. [PMID: 36013091 PMCID: PMC9409753 DOI: 10.3390/jcm11164854] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/10/2022] [Accepted: 08/16/2022] [Indexed: 11/17/2022] Open

Li P, Zhu Z, Tang X, Shi Z. A Mid-term Follow-up Study on the Reimplantation of Autoclaved Femoral and Tibial Components as Spacers for Treating Infected Total Knee Arthroplasty. Orthop Surg 2022;14:2042-2049. [PMID: 35894146 PMCID: PMC9483052 DOI: 10.1111/os.13402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 05/30/2022] [Accepted: 06/23/2022] [Indexed: 11/26/2022] Open

Abstract

Objective

Infection after total knee arthroplasty (TKA) is a rare but devastating complication. Different types of spaces have been used in two‐stage revision. The study aimed to evaluate the effect of autoclaved femoral and tibial components as spacers for treating periprosthetic infections after TKA.

Methods

A retrospective study was performed for 13 patients (five males, eight females) with a mean age of 69 ± 6 (range, 57–80) years and suffering from periprosthetic infection after TKA. They were treated with unconventional two‐stage revision from May 2008 to June 2017. In the first‐stage surgery, the autoclaved femoral and tibial components were reimplanted with a new liner as a spacer after a thorough debridement. After 4–6 months, the second‐stage surgery was performed according to the patients' requirements. The knee society score (KSS) and knee range of motion (ROM) were assessed before and after surgery. The reinfection rate was calculated.

Results

The mean duration of follow‐up was 5.7 ± 2.1 (range, 3.1–8.8) years. Culture‐positive infections comprised 69% of the cohort. All patients were able to walk 24 h after the first stage surgery, and the knee ROM could reach 90° in 1 week. Two patients (15.4%) experienced an infection recurrence. One patient was reinfected 1 year after the first stage surgery. Another patient developed reinfection 3 years after surgery but did not choose re‐revision and died of pneumonia. Only one patient underwent the second stage revision. The remaining 10 patients refused to receive a new prosthesis. At the time of the final follow‐up, six patients had slight pain in the knee while walking, and one patient required crutches to walk. There were no signs of prosthesis dislocation, rupture, deep vein thrombosis, pulmonary embolism, or delayed wound healing. No radiolucent lines or osteolysis were found. The mean KSS improved from 51 ± 10 (range, 35–63) points preoperatively to 79 ± 5 (range, 60–85) points at the final follow‐up. The average ROM before and after the first stage surgery were 62° ± 29° (range, 10°–100°) and 104° ± 9° (range, 90°–120°) (t = 4.659, P < 0.01) respectively. The infection control rate was 84.6%.

Conclusion

Reimplantation of the autoclaved original femoral and tibial components as an articulating spacer during the first stage surgery is a valuable addition for treating an infected TKA.

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Chuang CA, Lee SH, Chang CH, Hu CC, Shih HN, Ueng SWN, Chang Y. Application of structural allogenous bone graft in two-stage exchange arthroplasty for knee periprosthetic joint infection: a case control study. BMC Musculoskelet Disord 2022;23:325. [PMID: 35382827 PMCID: PMC8985362 DOI: 10.1186/s12891-022-05228-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 03/14/2022] [Indexed: 12/03/2022] Open

Abstract

Background

Knee prosthetic joint infection (PJI) is a common but devastating complication after knee arthroplasty. The revision surgeries for knee PJI may become more challenging when it is associated with large bone defects. The application of structural bone allograft in knee revision surgeries with large bone defects is not a new technique. However, there is a lack of literature reporting its efficacy in PJI cases. This study aimed to investigate the outcome of structural fresh frozen allogenous bone grafts in treating patients in knee PJI with large bone defects.

Methods

We performed a retrospective cohort analysis of knee PJI cases treated with two-stage exchange arthroplasty at our institution from 2010 to 2016. 12 patients with structural allogenous bone graft reconstructions were identified as the study group. 24 patients without structural allograft reconstructions matched with the study group by age, gender, and Charlson comorbidity index were enrolled as the control group. The functional outcome of the study group was evaluated with the Knee Society Score (KSS). Treatment success was assessed according to the Delphi-based consensus definition. The infection relapse rate and implant survivorship were compared between groups.

Results

Revision knees with structural allograft presented excellent improvement in the KSS (33.1 to 75.4). There was no significant difference between infection relapse-free survival rate and prosthesis survival rate in the two groups. The 8-year prosthesis survival rate was 90.9% in the study group and 91% in the control group (p = 0.913). The 8-year infection relapse-free survival rate was 80 and 83.3% in the study group and control group, respectively (p = 0.377).

Conclusion

The structural fresh frozen allogenous bone graft provided an effective way for bone defect reconstruction in knee PJI with an accountable survival rate. Meanwhile, using structural allografts did not increase the relapse rate of infection.

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Fei Z, Zhang Z, Wang Y, Zhang H, Xiang S. Comparing the Efficacy of Articulating Spacers in Two-Stage Revision for Periprosthetic Joint Infection Following Total Knee Arthroplasty: All-Cement Spacers vs Sterilized Replanted Metal-Polyethylene Spacers. Int J Gen Med 2022;15:3293-3301. [PMID: 35355797 PMCID: PMC8959870 DOI: 10.2147/ijgm.s354808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 03/16/2022] [Indexed: 12/16/2022] Open

Barretto JM, Campos ALS, Ooka NHM. Periprosthetic Knee Infection - Part 2: Treatment. Rev Bras Ortop 2022;57:193-199. [PMID: 35652024 PMCID: PMC9142269 DOI: 10.1055/s-0041-1729936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 12/17/2020] [Indexed: 11/29/2022] Open

Do Pre-Reimplantation Erythrocyte Sedimentation Rate/C-Reactive Protein Cutoffs Guide Decision-Making in Prosthetic Joint Infection? Are We Flying Blind? J Arthroplasty 2022;37:347-352. [PMID: 34742874 DOI: 10.1016/j.arth.2021.10.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/14/2021] [Accepted: 10/27/2021] [Indexed: 02/02/2023] Open

Bourgonjen YP, Hooning van Duyvenbode JFF, van Dijk B, Nurmohamed FRHA, Veltman ES, Vogely HC, van der Wal BCH. Long-term outcome of two-stage revision surgery after hip and knee prosthetic joint infections: an observational study. J Bone Jt Infect 2021;6:379-387. [PMID: 34745845 PMCID: PMC8564768 DOI: 10.5194/jbji-6-379-2021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/06/2021] [Indexed: 11/11/2022] Open

Abstract

Introduction: Two-stage revision surgery is the most frequently performed procedure in patients with a chronic periprosthetic joint infection (PJI). The infection eradication rates in the current literature differ between 54 % and 100 %, which could be attributed to different treatment strategies. The aim of this study was to retrospectively evaluate the infection eradication rate in patients with chronic PJI treated with two-stage revision surgery of the hip or knee in primary and re-revision cases. Methods: All patients treated with a two-stage revision for chronic PJI between 2005 and 2011 were analysed. Patient and infection characteristics were retrieved. Primary outcome was successful infection eradication at last follow-up. Successful eradication is specified as no need for subsequent revision surgery or suppressive antibiotic treatment. Results: Forty-seven patients were treated with a two-stage revision. Infection eradication was achieved in 36 out of 47 cases. Thirty-eight patients had positive cultures: 35 monomicrobial infections and 3 polymicrobial infections. Nine cases of culture-negative infections were identified. Accompanying eradication rates were 26 out of 35 cases, 2 out of 3 cases, and 8 out of 9 cases respectively. Mean follow-up was 128 (27–186) months. For hip and knee revisions the eradication rates were 22 out of 31 cases and 14 out of 16 cases respectively. After primary arthroplasty the infection was eradicated in 29 out of 38 cases and after re-revision in 7 out of 9 cases. Conclusion: In this study, the infection eradication rate for two-stage revision surgery after PJI of the hip and knee in primary and re-revision cases was 77 %. No statistically significant patient, infection and micro-organism characteristics were found which influence the infection eradication rates at long-term follow-up of 128 (27–186) months.

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Temporary new implant spacers increase post-reimplantation total knee prosthesis survival after periprosthetic joint infection. Knee Surg Sports Traumatol Arthrosc 2021;29:3621-3632. [PMID: 33083860 DOI: 10.1007/s00167-020-06325-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 10/06/2020] [Indexed: 01/04/2023]

Abstract

PURPOSE

Two-stage exchange arthroplasty is considered the gold standard for treatment of periprosthetic joint infection (PJI) following total knee arthroplasty (TKA). Antibiotic cement spacers can include cement-based spacers (CBS), new components (NEW), and autoclaved components (ACL). The factors that most influence post-reimplantation prosthesis (PRP) survival were determined.

METHODS

A retrospective database review of patients undergoing two-stage exchange arthroplasty from 2008 to 2014 was performed. There were 85 patients, 25 patients and 30 patients in CBS, NEW and ACL groups, respectively. Patient, disease and surgical characteristics were collected and analyzed. Post-reimplantation prosthesis (PRP) survival was modeled using the Kaplan-Meier method. Cox proportional hazard modeling was then performed to identify risk factors associated with implant failure.

RESULTS

Overall PRP survival was 82% in 140 unilateral TKAs. PRP survival between groups was 81%, 96% and 73% within the minimum 2-year follow-up period, respectively. There was a difference in median interval-to-reimplantation between groups (CBS, 72.0 days; NEW, 111.0 days; ACL, 84.0 days, p = 0.003). Adjusting for time-to-reimplantation, NEW spacers demonstrated greater PRP survival compared with ACL spacers (p = 0.044), and a trend towards greater survival compared with CBS spacers (p = 0.086). Excluding early failures (< 90 days), NEW spacers still demonstrated greater survival than ACL spacers (p = 0.046). Lower volume (≤ 10 within this series) surgeons tended to use more CBS spacers, while higher volume surgeons were comfortable with ACL spacers.

CONCLUSIONS

There was greater PRP survival with NEW spacers. NEW spacers also demonstrated an increased inter-stage interval, likely because of increased comfort and motion. There were spacer choice differences between low- and high-volume surgeons.

LEVEL OF EVIDENCE

III.

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Preoperative Serum C-Reactive Protein/Albumin Ratio Is a Predictor of Complications After Single-stage Revision for the Treatment of Periprosthetic Joint Infection. J Am Acad Orthop Surg 2021;29:e1013-e1024. [PMID: 34570745 DOI: 10.5435/jaaos-d-20-00613] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 08/29/2020] [Indexed: 02/01/2023] Open

Mohamed NS, Etcheson JI, Wilkie WA, Remily EA, Kluk MW, Thompson J, Plate JF, Mont MA, Delanois RE. Two-Stage Exchange Using a Short Intramedullary Nail for Treatment of Periprosthetic Knee Infections: A Technique Worth Questioning. J Knee Surg 2021;34:1322-1328. [PMID: 32330974 DOI: 10.1055/s-0040-1708856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]

Abstract

Periprosthetic joint infections (PJIs) following total knee arthroplasty (TKA) are serious orthopaedic complications that pose marked burdens to both patients and health care systems. At our institution, two-stage exchange with a temporary short antibiotic cement-coated intramedullary nail was utilized for the treatment of repeat PJIs in a series of compromised patients with considerable bone loss. This study reports on (1) success rates, (2) functional and pain outcomes, (3) and complications for patients receiving a temporary short intramedullary nail for the treatment of PJI. Our institutional database was queried for all repeat knee PJI patients between March 1st, 2009 and February 28th, 2015. Patients with type II/III Anderson Orthopaedic Research Institute (AORI) bone defects who underwent two-stage exchange arthroplasty with a short antibiotic-coated intramedullary nail were included for analysis (n = 31). Treatment success was determined using the Delphi-based consensus definition of a successfully treated PJI: infection eradication (healed wound with no recurrence of infection by the same organism), no further surgical intervention for infection after reimplantation, and no PJI-related mortality. A paired t-test was performed to assess for continuous variables. A total of 26 patients went on to reimplantation, while 5 patients retained the intramedullary nail. Overall treatment success was 74.2%. Range of motion significantly decreased postoperatively (102.1 vs. 87.3 degrees; p < 0.001), while Knee Society Scores (function) significantly increased (55.6 vs. 77.7, p < 0.001). A majority of patients were full weight-bearing immediately following surgery (38.7%). Treating poor health status patients with PJI of the knee can be difficult after multiple revisions. With a success rate similar to conventional methods, our results demonstrate that two-stage exchange with a temporary short intramedullary nail may be a desirable treatment option for patients with bony defects wishing to avoid amputation or permanent arthrodesis. However, this method does not outperform other treatment modalities, and may not be suitable for all patients. Patient expectations and health status should be carefully assessed to determine if this procedure is appropriate in this complex patient population.

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Hoshino T, Watanabe T, Nakagawa Y, Katagiri H, Ozeki N, Ohara T, Shioda M, Kono Y, Sekiya I, Koga H. Clinical outcomes of two-stage revision total knee arthroplasty in infected cases with antibiotic-loaded cement spacers produced using a handmade silicone mold. Knee Surg Relat Res 2021;33:27. [PMID: 34454632 PMCID: PMC8400397 DOI: 10.1186/s43019-021-00113-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 08/05/2021] [Indexed: 01/04/2023] Open

Affiliation(s)

Takashi Hoshino Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.,Department of Joint Surgery and Sports Medicine, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
Toshifumi Watanabe Department of Joint Surgery and Sports Medicine, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan. .,Second Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya-shi, Saitama, 343-8555, Japan.
Yusuke Nakagawa Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.,Department of Joint Surgery and Sports Medicine, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
Hiroki Katagiri Department of Joint Surgery and Sports Medicine, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.,Second Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya-shi, Saitama, 343-8555, Japan
Nobutake Ozeki Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
Toshiyuki Ohara Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
Mikio Shioda Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
Yuji Kono Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
Ichiro Sekiya Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
Hideyuki Koga Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.,Department of Joint Surgery and Sports Medicine, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan

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Matar HE, Bloch BV, Snape SE, James PJ. Outcomes of single- and two-stage revision total knee arthroplasty for chronic periprosthetic joint infection : long-term outcomes of changing clinical practice in a specialist centre. Bone Joint J 2021;103-B:1373-1379. [PMID: 34334036 DOI: 10.1302/0301-620x.103b8.bjj-2021-0224.r1] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]

Abstract

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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Xu H, Shang G, Wang Y, Xiang S. Plasma fibrinogen is a reliable marker for diagnosing periprosthetic joint infection and determining the timing of second-stage revision. Int J Infect Dis 2021;108:220-225. [PMID: 34089882 DOI: 10.1016/j.ijid.2021.05.068] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 01/04/2023] Open

Citak M, Luck S, Linke P, Gehrke T, Kühn KD. [Manual addition of antibiotics to industrial bone cement mixes : Investigations of the dry mix in the cement cartridge during manual admixture to polymer-active substance mixtures]. DER ORTHOPADE 2021;51:44-51. [PMID: 34032883 DOI: 10.1007/s00132-021-04115-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 11/28/2022]

Lo Presti M, Costa GG, Vasco C, Agrò G, Poggi A, Neri MP, Zaffagnini S. Küntscher nails with static cement spacer: A simple technique in periprosthetic knee infections with massive bone loss and instability. Knee 2021;29:580-588. [PMID: 33736904 DOI: 10.1016/j.knee.2021.01.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 12/20/2020] [Accepted: 01/24/2021] [Indexed: 02/02/2023]

Wolff M, Lausmann C, Gehrke T, Zahar A, Ohlmeier M, Citak M. Results at 10-24 years after single-stage revision arthroplasty of infected total hip arthroplasty in patients under 45 years of age. Hip Int 2021;31:237-241. [PMID: 31766882 DOI: 10.1177/1120700019888877] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]

Abstract

INTRODUCTION

The management of periprosthetic joint infection (PJI) of the hip is a challenging procedure. One-stage exchange is carried out in specialist centres with comparable infection free survival rates. However, there is a paucity of long-term results of this approach in young patients.

METHODS

All patients undergoing one-stage exchange due to PJI with a known causative organism ⩽45 years of age with a minimum of 10-year follow-up (mean 15 years; range 10-24 years) were enrolled in this retrospective study. Patients older than 45 years of age or patients with a two-stage procedure were excluded from the study. The primary outcome measure was failure rate with special focus on reinfection at latest follow-up. Failure was defined as revision surgery for infection. Furthermore, functional outcome using the Harris Hip Score was determined initially and at latest follow-up. 26 patients fulfilled the inclusion criteria and were available for final follow-up.

RESULTS

The study cohort consists of 16 male and 10 female patients with a mean age of 36.8 years (range 20-45 years) and a mean BMI of 29.8 kg/m2 (range 20.7-40.6 kg/m2). Prior to the single-stage procedure, the patients underwent an average of 3.1 previous surgical interventions (range 1-9). The mean hospital stay after septic revision was 19.7 days (11-33 days). Most infections were caused by Staphylococcus epidermidis (n = 8, 30.8%), followed by Staph. aureus (n = 7, 26.9%) and Propionibacterium acnes (n = 6, 23.1%). At latest follow-up, the overall survival rate was 76.9 %, while infection control could be achieved in 96.2%. At final examination, the mean Harris Hip Score improved from 46.2 to 78.9 (range 18.0-99; SD, 22.6).

CONCLUSIONS

Single-stage revision surgery for the management of PJI in patients ⩽45 years is a successful treatment option with high infection control, even after long-term follow-up.

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Rossi SMP, Medetti M, Perticarini L, Ghiara M, Benazzo F. Customized intraoperatively molded articulating cement spacers for two-stage revisions TKA with major bone defects. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021;31:1121-1128. [PMID: 33417052 DOI: 10.1007/s00590-020-02844-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 12/03/2020] [Indexed: 11/26/2022]

Klemt C, Tirumala V, Oganesyan R, Xiong L, van den Kieboom J, Kwon YM. Single-Stage Revision of the Infected Total Knee Arthroplasty Is Associated With Improved Functional Outcomes: A Propensity Score-Matched Cohort Study. J Arthroplasty 2021;36:298-304. [PMID: 32778418 DOI: 10.1016/j.arth.2020.07.012] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/30/2020] [Accepted: 07/06/2020] [Indexed: 02/02/2023] Open

Abstract

BACKGROUND

Single-stage revision is an alternative to the standard 2-stage revision, potentially minimizing morbidities and improving functional outcomes. This study aimed at comparing single-stage and 2-stage revision total knee arthroplasty (TKA) for chronic periprosthetic joint infection (PJI) with regard to patient-reported outcome measures (PROMs) and complication rates.

METHODS

A total of 185 consecutive revision TKA patients for chronic PJI with complete preoperative and postoperative PROMs were investigated. A total of 44 patients with single-stage revision TKA were matched to 88 patients following 2-stage revision TKA using propensity score matching, yielding a total of 132 propensity score-matched patients for analysis. Patient demographics and clinical information including reinfection and readmission rates were evaluated.

RESULTS

There was no significant difference in preoperative PROMs between propensity score-matched single-stage and 2-stage revision TKA cohorts. Postoperatively, significantly higher PROMs for single-stage revision TKA were observed for Knee disability and Osteoarthritis Outcome Score physical function (62.2 vs 51.9, P < .01), physical function short form 10A (42.8 vs 38.1, P < .01), PROMIS SF Physical (44.8 vs 41.0, P = .01), and PROMIS SF Mental (50.5 vs 47.1, P = .02). There was no difference between propensity score-matched single-stage and 2-stage revision TKA cohorts for clinical outcomes including reinfection rates (25.0% vs 27.2%, P = .78) and 90-day readmission rates (22.7% vs 25.0%, P = .77).

CONCLUSION

This study illustrated that single-stage revision TKA for chronic PJI may be associated with superior patient-reported outcomes compared to 2-stage revision for the infected TKA using a variety of PROMs. Improved PROMs were not accompanied by differences in complication rates between both cohorts, suggesting that single-stage revision TKA may provide an effective alternative to 2-stage revision in patients with chronic TKA PJI.

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Sabah SA, Alvand A, Price AJ. Revision knee replacement for prosthetic joint infection: Epidemiology, clinical outcomes and health-economic considerations. Knee 2021;28:417-421. [PMID: 33500184 DOI: 10.1016/j.knee.2020.12.024] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 12/21/2020] [Indexed: 02/02/2023]

Vielgut I, Schwantzer G, Leithner A, Sadoghi P, Berzins U, Glehr M. Successful Two-Stage Exchange Arthroplasty for Periprosthetic Infection Following Total Knee Arthroplasty: The Impact of Timing on Eradication of Infection. Int J Med Sci 2021;18:1000-1006. [PMID: 33456357 PMCID: PMC7807194 DOI: 10.7150/ijms.47655] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 11/30/2020] [Indexed: 12/17/2022] Open

Abstract

Background: Periprosthetic joint infection (PJI) represents a serious complication following total knee arthroplasty. In the setting of chronic infections, the two-staged approach has traditionally been the preferred treatment method. The aim of this study was to determine the optimal period of rest between the first and second stage. Furthermore, we analyzed potentially outcome-relevant parameters, such as general and local conditions and the presence of difficult-to-treat or unidentified microorganisms, with regard to their impact on successful treatment of PJI. Patients and Methods: We performed a retrospective analysis of prospectively collected data for all patients treated for PJI at our institution. Seventy-seven patients who had undergone two-stage revision arthroplasty for PJI of the knee were included into the study. Antibiotic-loaded cement spacers were used for all patients. Results: After a median follow-up time of 24.5 months, infection had reoccurred in 14 (18.7%) patients. A prolonged spacer-retention period of more than 83 days was related to a significantly higher proportion of reinfections. Furthermore, significant compromising local conditions of the prosthetic tissue and surrounding skin, as well as repeated spacer-exchanges between first- and second-stage surgery, negatively influenced the outcome. Neither the patients' age nor gender exerted a significant influence on the outcome regarding reinfection rates for patients' age or gender. Conclusions: We observed the best outcome regarding infection control in patients who had undergone second-stage surgery within 12 weeks after first-stage surgery. Nearly 90% of these patients stayed free from infection until the final follow-up. An increased number of performed spacer-exchanges and a bad local extremity grade also had a negative impact on the outcome.

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How I do it - Second stage revision total knee arthroplasty. Knee 2020;27:2007-2012. [PMID: 32891487 DOI: 10.1016/j.knee.2020.08.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/01/2020] [Accepted: 08/07/2020] [Indexed: 02/02/2023]

Elevated ESR/CRP Ratio Is Associated With Reinfection After Debridement, Antibiotics, and Implant Retention in Chronic Periprosthetic Joint Infections. J Arthroplasty 2020;35:3254-3260. [PMID: 32631730 DOI: 10.1016/j.arth.2020.06.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/22/2020] [Accepted: 06/03/2020] [Indexed: 02/02/2023] Open

Abstract

BACKGROUND

Ratios of established inflammatory markers, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), have been used for diagnostic purposes in the surgical field; however, the ESR:CRP ratio (ECR) has not been evaluated as a marker for predicting infection resolution in patients with periprosthetic joint infections (PJIs). This study aimed to evaluate the diagnostic accuracy of ECR in predicting postoperative reinfection in patients who underwent debridement, antibiotics, and implant retention (DAIR).

METHODS

This is a retrospective review of 179 consecutive patients who underwent DAIR revision total joint arthroplasty for PJI. Patients were stratified by acuity of their infection: acute PJI, acute hematogenous PJI, and chronic PJI. The area under the receiver operating characteristic curve was calculated to evaluate ECR as diagnostic marker for predicting postoperative reinfection in patients who underwent DAIR.

RESULTS

Statistically significant differences in ECR were found in patients who underwent DAIR revision total joint arthroplasty for chronic infection (1.23 vs 2.33; P = .04). There was no significant difference in ECR in patients who underwent DAIR for acute infection (P = .70) and acute hematogenous infection (P = .56). In patients who underwent DAIR for chronic PJI, ECR demonstrated a sensitivity and specificity of 75% and 84%, respectively, for the prediction of postoperative reinfection, which was significantly higher than that of ESR (sensitivity, 67%; specificity, 47%; P < .001) and CRP (sensitivity, 50%; specificity, 26%; P < .001).

CONCLUSION

Elevated ECR was associated with an increased reinfection risk in patients who underwent DAIR for chronic PJI, suggesting that preoperative ECR may be a useful predictor to identify patients at increased risk of reinfection after DAIR for chronic PJIs.

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Leta TH, Lygre SHL, Schrama JC, Hallan G, Gjertsen JE, Dale H, Furnes O. Outcome of Revision Surgery for Infection After Total Knee Arthroplasty: Results of 3 Surgical Strategies. JBJS Rev 2020;7:e4. [PMID: 31188156 DOI: 10.2106/jbjs.rvw.18.00084] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]

Abstract

BACKGROUND

Periprosthetic joint infection (PJI) after knee arthroplasty surgery remains a serious complication, yet there is no international consensus regarding the surgical treatment of PJI. This study aimed to assess prosthesis survival rates, risk of revision, and mortality rate following different surgical strategies (1-stage versus 2-stage implant revision and irrigation and debridement with implant retention) that are used to treat PJI.

METHODS

The study was based on 644 total knee arthroplasties (TKAs) that were revised because of a deep infection (i.e., surgically treated PJI) and reported to the Norwegian Arthroplasty Register (NAR) from 1994 to 2016. Kaplan-Meier and multiple Cox regression analyses were performed to assess implant survival rate and risk of revision. We also studied mortality rates at 90 days and 1 year after revision for PJI.

RESULTS

During the follow-up period, 19% of the irrigation and debridement cases, 14% of the 1-stage revision cases, and 12% of the 2-stage revision cases underwent a subsequent revision because of a PJI. The 5-year Kaplan-Meier survival rate with revision for infection as the end point was 79% after irrigation and debridement, 87% after 1-stage revision, and 87% after 2-stage revision. There were no significant differences between 1-stage and 2-stage revisions with subsequent revision for any reason as the end point (relative risk [RR], 1.7; 95% confidence interval [CI], 0.9 to 3.5) and no difference with revision because of infection as the end point (RR, 1.6; 95% CI, 0.7 to 3.7). In an age-stratified analysis, however, the risk of revision for any reason was 4 times greater after 1-stage revision than after 2-stage revision in patients over the age of 70 years (RR, 4.3; 95% CI, 1.3 to 14.8). Age had no significant effect on the risk of subsequent revision for knees that had been revised with the irrigation and debridement procedure. The 90-day and 1-year mortality rates after revision for PJI were 1.2% and 2.5%, respectively.

CONCLUSIONS

Irrigation and debridement yielded good results compared with previous published studies. Although the 1-stage revisions resulted in a fourfold increase in risk of subsequent revision compared with the 2-stage revisions in older patients, the overall outcomes after 1-stage and 2-stage revisions were similar.

LEVEL OF EVIDENCE

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Warth LC, Hadley CJ, Grossman EL. Two-Stage Treatment for Total Knee Arthroplasty Infection Utilizing an Articulating Prefabricated Antibiotic Spacer. J Arthroplasty 2020;35:S57-S62. [PMID: 32046834 DOI: 10.1016/j.arth.2019.10.049] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 10/24/2019] [Accepted: 10/24/2019] [Indexed: 02/01/2023] Open

Veltman ES, Moojen DJF, van Ogtrop ML, Poolman RW. Two-stage revision arthroplasty for coagulase-negative staphylococcal periprosthetic joint infection of the hip and knee. World J Orthop 2019;10:348-355. [PMID: 31750083 PMCID: PMC6854054 DOI: 10.5312/wjo.v10.i10.348] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 08/14/2019] [Accepted: 09/05/2019] [Indexed: 02/06/2023] Open

Veltman ES, Moojen DJF, Ogtrop MLV, Poolman RW. Two-stage revision arthroplasty for coagulase-negative staphylococcal periprosthetic joint infection of the hip and knee. World J Orthop 2019. [DOI: 10.5312/wjo.v10.i10.340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open