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One-stage versus two-stage exchange arthroplasty for infected total knee arthroplasty: a systematic review

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Infection complicating total knee arthroplasty (TKA) has serious implications. Traditionally the debate on whether one- or two-stage exchange arthroplasty is the optimum management of infected TKA has favoured two-stage procedures; however, a paradigm shift in opinion is emerging. This study aimed to establish whether current evidence supports one-stage revision for managing infected TKA based on reinfection rates and functional outcomes post-surgery.

Methods

MEDLINE/PubMed and CENTRAL databases were reviewed for studies that compared one- and two-stage exchange arthroplasty TKA in more than ten patients with a minimum 2-year follow-up.

Results

From an initial sample of 796, five cohort studies with a total of 231 patients (46 single-stage/185 two-stage; median patient age 66 years, range 61–71 years) met inclusion criteria. Overall, there were no significant differences in risk of reinfection following one- or two-stage exchange arthroplasty (OR −0.06, 95 % confidence interval −0.13, 0.01). Subgroup analysis revealed that in studies published since 2000, one-stage procedures have a significantly lower reinfection rate. One study investigated functional outcomes and reported that one-stage surgery was associated with superior functional outcomes. Scarcity of data, inconsistent study designs, surgical technique and antibiotic regime disparities limit recommendations that can be made.

Conclusion

Recent studies suggest one-stage exchange arthroplasty may provide superior outcomes, including lower reinfection rates and superior function, in select patients. Clinically, for some patients, one-stage exchange arthroplasty may represent optimum treatment; however, patient selection criteria and key components of surgical and post-operative anti-microbial management remain to be defined.

Level of evidence

III.

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Authors and Affiliations

  1. Medical Sciences Division, John Radcliffe Hospital, Oxford University Clinical Academic Graduate School, Oxford, OX3 9DU, UK

    Navraj S. Nagra

  2. Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Botnar Research Centre, University of Oxford, Oxford, OX3 7LD, UK

    Navraj S. Nagra, Thomas W. Hamilton, Sameer Ganatra, David W. Murray & Hemant Pandit

Authors
  1. Navraj S. Nagra
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  2. Thomas W. Hamilton
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  3. Sameer Ganatra
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  5. Hemant Pandit
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Corresponding author

Correspondence to Thomas W. Hamilton.

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Each author certifies that he or she has no commercial associations (e.g. consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article. All work was performed at the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Botnar Research Centre, Windmill Road, Oxford OX3 7LD, UK.

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Nagra, N.S., Hamilton, T.W., Ganatra, S. et al. One-stage versus two-stage exchange arthroplasty for infected total knee arthroplasty: a systematic review. Knee Surg Sports Traumatol Arthrosc 24, 3106–3114 (2016). https://doi.org/10.1007/s00167-015-3780-8

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  • DOI: https://doi.org/10.1007/s00167-015-3780-8

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