Systematic review of single stage revision for prosthetic joint infection

Table 1 Single stage revision outcomes for total knee arthroplasty and total hip arthroplasty

Ref.	Year	PJI	Cases	Reinfection	Follow-up (in year)
Freeman et al[47]	1985	Knee	8	0	2
Göksan et al[48]	1992	Knee	18	2 (11%)	5
Scott et al[49]	1993	Knee	10	3 (30%)
Silva et al[50]	2002	Knee	37	4 (11%)	5
Buechel et al[51]	2004	Knee	22	2 (9%)	10
Whiteside et al[52]	2011	Knee	18	1 (6%)	5.2
Parkinson et al[53]	2011	Knee	22	0	2
Singer et al[54]	2012	Knee	63	3 (5%)	3
Klatte et al[55]	2014	Knee	4	1 (25%)	2.1
Tibrewal et al[13]	2014	Knee	50	1 (2%)	10.5
Haddad et al[14]	2015	Knee	28	0	6.5
Labruyère et al[56]	2015	Knee	9	0	5
Holland et al[57]	2019	Knee	26	1 (4%)	5.3
Siddiqi et al[58]	2019	TKA	57	8 (14%)	4.4
Abdelaziz et al[59]	2020	TKA	72	8 (11%)	4.2
Ji et al[60]	2020	Both	51	5 (10%)	4.4
Carlsson et al[61]	1978	Hip	77	17 (22%)
Hughes et al[62]	1979	Hip	13	4 (31%)
Buchholz et al[2]	1981	Hip	640	130 (20%)	4.3
Miley et al[63]	1982	Hip	47	6 (13%)	4
Weber et al[64]	1986	Hip	8	2 (25%)	6
Wroblewski et al[4]	1986	Hip	102	9 (9%)	3.2
Sanzén et al[65]	1988	Hip	102	25 (25%)	7
Hope et al[66]	1989	Hip	72	9 (13%)	3.75
Raut et al[67]	1994	Hip	57	8 (14%)	7.3
Mulcahy et al[68]	1996	Hip	15	0	4
Ure et al[69]	1998	Hip	22	0	10.5
Callaghan et al[6]	1999	Hip	24	2 (8%)	10
Rudelli et al[70]	2008	Hip	32	2 (6%)	5
Winkler et al[71]	2008	Hip	37	3 (8%)	4.4
Yoo et al[72]	2008	Hip	12	1 (8%)	7.2
Oussedik et al[39]	2010	Hip	11	0	6.8
De Man et al[40]	2011	Hip	22	0	3.8
Klouche et al[11]	2012	Hip	38	0	2
Choi et al[73]	2013	Hip	17	3 (18%)	5.1
Hansen et al[26]	2013	Hip	27	8 (30%)	2.25
Bori et al[46]	2014	Hip	24	1 (4%)	3.6
Jenny et al[74]	2014	Hip	65	17 (26%)	5
Klatte et al[55]	2014	Hip	6	0	2.1
Wolf et al[27]	2014	Hip	37	24 (65%)	2
Zeller et al[5]	2014	Hip	157	8 (5%)	3.4
Ebied et al[75]	2016	Hip	33	1 (3%)	6
Ilchman et al[76]	2016	Hip	39	0	6.6
Born et al[77]	2016	Hip	28	0	7
Lange et al[78]	2017	Hip	56	5 (91%)	4
Whiteside et al[79]	2017	Hip	21	1 (95%)	5.2
Zahar et al[80]	2018	Hip	85	5 (6%)	10.5
Bori et al[81]	2018	Hip	19	1 (5%)
Wolff et al[82]	2019	Hip	26	1 (96%)	15
Ji et al[24]	2019	Hip	111	12 (11%)	4.8

Study author listed, year of publication, joint investigated, number of cases, reinfection rate, and follow up reported. PJI: Prosthetic joint infections.

Table 2 Bactericidal antibiotics vs bacteriostatic antibiotics

Bactericidal antibiotics	Bacteriostatic
Aminoglycosides, cephalosporins, fluoroquinolones, metronidazole, penicillin, vancomycin	Chloramphenicol, clindamycin, erythromycin, sulfamethoxazole, tetracycline, trimethoprim

It is important to use local bacteriocidal antibiotics to combat periprosthetic joint infection in single stage revision. The exception is clindamycin where it has been reported to have success in single stage revision for infection.

Table 3 International Consensus Meeting 2018 Guidelines for prosthetic joint infection for hip and knee arthroplasty

Major criteria
Two positive cultures of the same organism / Sinus tract with communication to the joint or prosthesis
Minor criteria
Criteria	Acute threshold	Chronic threshold	Score
CRP (mg/L) or D Dimer (ug/L)	100; unknown	10; 860	2
ESR (mm/h)	No role	30	1
Synovial WBC or leukocyte esterase or alpha defensin	10000; ++; 1.0	3000; ++; 1.0	2
Synovial PMN %	90	70	2
Single positive culture			2
Positive histology			3
Positive intraoperative purulence			3

A positive prosthetic joint infection is one of two major criteria, or 6 or more points for minor criteria. 3-5 points for minor criteria is inconclusive and less than 3 points is negative for prosthetic joint infection. WBC: White blood cell; PJI: Prosthetic joint infection; CRP: C-reactive protein; ESR: Erythrocyte sedimentation rate; PMN: Polymorphonuclearleukocyte.

Table 4 McPherson host class comorbidities

Systemic host compromising factors
Age ≥ 80 yr	Alcoholism	Chronic cellulitis or dermatitis
Chronic indwelling catheter	Malnutrition (albumin < 3 g/dL)	Current nicotine use
Diabetes	Hepatic insuffiency	Immunosuppressive drugs
Malignancy (history or active)	Pulmonary insuffiency	Renal failure on dialysis
Systemic inflammatory disease	Systemic immune compromised disease or infection (HIV, AIDS)

McPherson hip infection classification comprises of infection type, host type and local factors. Host factors are graded A, B or C. A has none of the listed factors, B has 2 or fewer factors, C has 3 or more factors or severe immunocompromise defined by: absolute neutrophil count < 1000/mm³, CD₄ T cell count < 100/mm³, intravenous drug abuse, or dysplasia or neoplasm of the immune system. HIV: Human immunodeficiency virus; AIDS: Acquired immune deficiency syndrome.

Table 5 International consensus meeting indications and contra-indications for single stage revision for prosthetic joint infection

Indications	Contra-indications
Non-immunocompromised host	Severe damage to soft tissues were direct closure not possible or inexcisable complex sinus tract with old scar
Absence of systemic sepsis	Culture negative PJI
Minimal bone/soft tissue loss allowing primary closure	Inability to perform radical debridement
Isolation of pathologic organism preoperatively	Unable to give local antibiotic treatment
Known sensitivities to bactericidal treatment	No proper bone stock available for fixation

PJI: Prosthetic joint infection.