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High Infection Control Rate and Function After Routine One-stage Exchange for Chronically Infected TKA

  • Symposium: Papers Presented at the Annual Meetings of the Knee Society
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Many surgeons consider two-stage exchange the gold standard for treating chronic infection after TKA. One-stage exchange is an alternative for infection control and might provide better knee function, but the rates of infection control and levels of function are unclear.

Questions/Purposes

We asked whether a one-stage exchange protocol would lead to infection control rates and knee function similar to those after two-stage exchange.

Methods

We followed all 47 patients with chronically infected TKAs treated with one-stage exchange between July 2004 and February 2007. We monitored for recurrence of infection and obtained Knee Society Scores. We followed patients a minimum of 3 years or until death or infection recurrence.

Results

Three of the 47 patients (6%) experienced a persistence or recurrence of the index infection with the same pathogen isolated. Three patients (6%) had control of the index infection but between 6 and 17 months experienced an infection with another pathogen. The 3-year survival rates were 87% for being free of any infection and 91% for being healed of the index infection. Twenty-five of the 45 patients (56%) had a Knee Society Score of more than 150 points.

Conclusions

While routine one-stage exchange was not associated with a higher rate of infection recurrence failure, knee function was not improved compared to that of historical patients having two-stage exchange. One stage-exchange may be a reasonable alternative in chronically infected TKA as a more convenient approach for patients without the risks of two operations and hospitalizations and for reducing costs. The ideal one stage-exchange candidate should be identified in future studies.

Level of Evidence

Level IV, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

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Author information

Authors and Affiliations

  1. Center for Orthopedic and Hand Surgery, University Hospital of Strasbourg, 10 Avenue Baumann, F-67400, Illkirch, France

    Jean-Yves Jenny MD, Bruno Barbe MD, Jeannot Gaudias MD & Cyril Boeri MD

  2. Institute for Locomotion and Center for Arthritis Surgery, Sainte-Marguerite Hospital, Aix-Marseille University, Marseille, France

    Jean-Noël Argenson MD

Authors
  1. Jean-Yves Jenny MD
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  2. Bruno Barbe MD
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  3. Jeannot Gaudias MD
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  4. Cyril Boeri MD
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  5. Jean-Noël Argenson MD
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Corresponding author

Correspondence to Jean-Yves Jenny MD.

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Each author certifies that he or she, or a member of his or her immediate family, has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at the University Hospital of Strasbourg, Illkirch, France.

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Jenny, JY., Barbe, B., Gaudias, J. et al. High Infection Control Rate and Function After Routine One-stage Exchange for Chronically Infected TKA. Clin Orthop Relat Res 471, 238–243 (2013). https://doi.org/10.1007/s11999-012-2480-7

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  • DOI: https://doi.org/10.1007/s11999-012-2480-7

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