Patient reported outcome measures after revision of the infected TKR: comparison of single versus two-stage revision
Two-stage revision is the ‘gold standard’ treatment for infected total knee replacement. Single-stage revision has been successful in the hip and, in carefully chosen knee revisions, may offer the advantage of a single surgical insult with improved functional outcome.
Patient Reported Outcome Measures (PROMs) for 33 single- and 89 two-stage revisions performed for infection were analysed in combination with data from the National Joint Registry for England and Wales. Outcomes including the Oxford Knee Score (OKS), Euroqol-5D (EQ5D) and patient satisfaction were examined with the aim of investigating the following questions: does single- or two-stage revision for infection result in (1) better knee function; (2) better overall perception of health status; (3) better patient perceived success and satisfaction?
No statistical difference was found between the groups for any reported outcome measure. Mean OKS following surgery was 24.9 (95 %CI, 20.5–29.4) for single- and 22.8 (95 %CI, 20.2–25.4) for two-stage (n.s.). Mean EQ5D index following surgery was 0.495 (95 %CI, 0.357–0.632) for single and 0.473 (95 %CI, 0.397–0.548) for two-stage (n.s.). Patients reporting Excellent/Very good/Good satisfaction were similar between the groups (single = 61 % vs. two stage = 57 %, (n.s.)). In total, 66 % single- and 60 % two-stage operations were rated ‘successful’ (n.s.).
This study found no demonstrable benefit of single-stage compared to two-stage revision for the infected total knee replacement using a variety of PROMs. Thus, we recommend that decision making must be based on other factors such as re-infection rate.
Level of evidence
KeywordsInfection Revision Single stage Two stage Knee arthroplasty Outcomes
We thank the patients and staff of all the hospitals in England and Wales, who have contributed data to the National Joint Registry. We are grateful to the Healthcare Quality Improvement Partnership (HQIP), the NJR Steering Committee and the staff at the NJR centre for facilitating this work. This work was funded by a fellowship from the National Joint Registry. The authors have conformed to the NJR’s standard protocol for data access and publication. The views expressed represent those of the authors and do not necessarily reflect those of the National Joint Register Steering Committee or the Health Quality Improvement Partnership (HQIP) who do not vouch for how the information is presented.
- 2.Baker PN, van der Meulen JH, Lewsey J, Gregg PJ (2007) The role of pain and function in determining patient satisfaction after total knee replacement. Data from the National Joint Registry for England and Wales. J Bone Jt Surg (Br) 89-B:893–900Google Scholar
- 6.Buechel FF, Femino FP, D’Alessio J (2004) Primary exchange revision arthroplasty for infected total knee replacement: a long-term study. Am J Orthop (Belle Mead NJ) 33:190–198Google Scholar
- 9.Euroqol (EQ5D) score. Accessed at http://www.euroqol.org/home.html. Last Accessed 8th June 2011
- 12.Göksan SB, Freeman MAR (1992) One-Stage reimplantation for infected total knee arthroplasty. J Bone Jt Surg (Br) 74-B:78–82Google Scholar
- 15.Insall JN, Thompson FM, Brause BD (1983) Two-stage reimplantation for the salvage of infected total knee arthroplasty. J Bone Jt Surg (Am) 65:1087–1098Google Scholar
- 19.Leone S, Borre S, D’Arminio Monforte A, Mordente G, Petrosillo N, Signore A, Venditti M, Viale P, Nicastri E, Lauria FN, Carosi G, Moroni M, Ippolito G, and the GISIG (2010) Consensus document on controversial issues in the diagnosis and treatment of prosthetic joint infections. Int J Infect Dis 14S4:S67–S77Google Scholar
- 25.Scott IR, Stockley I, Getty CJM (1993) Exchange arthroplasty for infected knee replacements. A new two-staged method. J Bone Jt Surg (Br) 75-B:28–31Google Scholar
- 26.Smith SC, Cano S, Lamping DL, Staniszewska S, Browne J, Lewsey J, van der Meulen J, Ciarns J, Black N (2005) Patient-Reported Outcome Measures (PROMs) for routine use in Treatment Centres: recommendations based on a review of the scientific evidence. Final report to the Department of Health, December 2005. http://www.wmqi.westmidlands.nhs.uk/downloads/file/ PROMS %20Final %20report %20Dec %2005.pdf
- 28.von Foerster G, Klüber D, Käbler U (1991) Mid- to long-term results after treatment of 118 cases of periprosthetic infections after knee joint replacement using one-stage exchange surgery. Orthopade 20:244–252Google Scholar