Abstract
Introduction
To review our practice of performing two-stage revision for infected total knee arthroplasty using articulating interval prosthesis and to compare the incidence of the recurrence of infection and re-operation rate in patients undergoing two-stage revision as planned with the group of patients who choose not to proceed to the second stage.
Method
This study is a retrospective review of 60 consecutive patients undergoing a two-stage revision for infected total knee arthroplasty using articulating interval prosthesis. All cases managed by a single surgeon using a uniform peri-operative protocol, and short-course parenteral antibiotic therapy.
Result
Thirty-four patients (57 %) (Group 1) underwent the two-stage revision as planned. However, twenty-six patients (43 %) (Group 2) opted not to have a second-stage procedure as the first-stage and interval prosthesis had eradicated the infection, resolved the pain and achieved good functional outcome. There were five cases of recurrent infection in the 60 patients (8 %) at a mean follow-up 5 years. In those completing the two-stage revision, two patients had recurrent infection. Of the patients who retained the interval prosthesis, there were three recurrent infections. There was no statistically significant difference between the groups in terms of recurrence of infection or re-revision.
Conclusion
Two-stage revision with interval prostheses represents a safe and reliable method of treating infected knee prosthesis; however, there may be a role for one-stage revision in selected cases.
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References
Rand JA, Bryan RS, Morrey BF, Westholm F (1986) Management of infected total knee arthroplasty. Clin Orthop Relat Res 205:75–85
Bengston S, Knutson K, Lidgren L (1989) Treatment of infected knee arthroplasty. Clin Orthop Relat Res 245:173–178
Blom AW, Brown J, Taylor AH, Pattison G, Whitehouse S, Bannister GC (2004) Infection after total knee arthroplasty. J Bone Joint Surg Br 86(B):688–691
Insall JN, Thompson FM, Brause BD (1983) Two-stage reimplantation for the salvage of infected total knee arthroplasty. J Bone Joint Surg Am 65(8):1087–1098
Wilde AH, Ruth JT (1988) Two-stage reimplantation in infected total knee arthroplasty. Clin Orthop 236:23
Goldman RT, Scuderi GR, Insall JN (1996) Two-Stage reimplantation for infected total knee replacement. Clin Orthop 331:118
Simmons TD, Stern SH (1996) Diagnosis and management of the infected total knee arthroplasty. Am J Knee Surg 2:99
Windsor RE, Insall JN, Urs WK et al (1990) Two-stage reimplantation for the salvage of total knee arthroplasty complicated by infection. Further follow-up and refinement of indications. J Bone Joint Surg Am 72:272
Haddad FS, Masri BA, Campbell D, McGraw RW, Beauchamp CP, Duncan CP (2000) The PROSTALAC functional spacer in two-stage revision for infected knee replacements. Prosthesis of antibiotic-loaded acrylic cement. J Bone Joint Surg Br 82:807–812
Trezies A, Parish E, Dixon P, Cross M (2006) The use of an articulating spacer in the management of infected total knee arthroplasties. J Arthroplasty 21(5):702–704
Weber FA, Lautenbach EEG (1986) Revision of infected total hip arthroplasty. Clin Orthop 211:108–115
Hofmann AA, Kane KR, Tkach TK et al (1995) Treatment of infected total knee arthroplasty using an articulating spacer. Clin Orthop 321:45
Hofmann AA, Goldberg T, Tanner A et al (2005) Treatment of infected total knee arthroplasty using an articulating spacer: 2- to 12-year experience. Clin Orthop 430:125
Fehring TK, Odum S, Calton TF et al (2000) Articulating versus static spacers in revision total knee arthroplasty for sepsis. Clin Orthop 380:9
Wroblewski BM (1986) One-stage revision of infected cemented total hip arthroplasty. Clin Orthop Relat Res 211:103–107
Callaghan JJ, Katz RP, Johnston RC (1999) One-stage revision surgery of the infected hip. A minimum 10-year followup study. Clin Orthop Relat Res 369:139–143
Rudelli S, Uip D, Honda E, Lima AL (2008) One-stage revision of infected total hip arthroplasty with bone graft. J Arthroplasty 23(8):1165–1177
Kotwal R, Prasad N, Morgan-Jones R (2009) One stage revision for infected total knee arthroplasty. BASK meeting Edinburgh
Parkinson RW, Kay PR, Rawal A (2011) A case for one-stage revision in infected total knee arthroplasty? Knee 18(1):1–4
Bauer T, Piriou P, Lhotellier L, Leclerc P, Mamoudy P, Lortat-Jacob A (2006) Results of reimplantation for infected total knee arthroplasty: 107 cases. Rev Chir Orthop Reparatrice Appar Mot 92(7):692–700
Parvizi J, Gehrke T, Chen AF (2013) Proceedings of the international consensus on peri-prosthetic joint infection. Bone Joint J 95-B:1450–1452
Costerton JW (1999) Bacterial biofilms: a common cause of persistent infections. Science 284:1318–1322
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Prasad, N., Paringe, V., Kotwal, R. et al. Two-stage revision for infected total knee arthroplasty: our experience with interval prosthesis. Eur J Orthop Surg Traumatol 24, 1279–1283 (2014). https://doi.org/10.1007/s00590-013-1380-1
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DOI: https://doi.org/10.1007/s00590-013-1380-1