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Two-stage Exchange Arthroplasty for Infected Total Knee Arthroplasty: Predictors of Failure

  • Symposium: Papers Presented at the 2010 Meeting of the Musculoskeletal Infection Society
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

In North America, a two-stage exchange arthroplasty remains the preferred surgical treatment for chronic periprosthetic joint infection (PJI). Currently, there are no proper indicators that can guide orthopaedic surgeons in patient selection for two-stage exchange or the appropriate conditions in which to reimplant.

Questions/purposes

To identify (1) the rate of recurrent PJI after two-stage exchange and (2) the role of 15 presurgical and 11 operative factors in influencing the outcome of two-stage revision.

Patients and Methods

From a prospective database we identified 117 patients who had undergone two-stage exchange arthroplasty for PJI of the knee from 1997 to 2007. Failure of two-stage revision was defined as any treated knee requiring further treatment for PJI. We identified 15 presurgical and 11 surgical factors that might be related to failure. Minimum followup was 2 years (average, 3.4 years; range, 2–9.4 years).

Results

Thirty-three of 117 reimplantations (28%) required reoperation for infection. Age, gender, body mass index, and comorbidity indices were similar in both groups. Multivariate analysis provided culture-negative (odds ratio [OR], 4.5; 95% confidence interval [CI], 1.3–15.7), methicillin-resistant organisms (OR, 2.8; 95% CI, 0.8–10.3), and increased reimplantation operative time (OR, 1.01; 95% CI, 1.0–1.03) as predictors of failure. ESR and CRP values at the time of reimplantation and time from resection to reimplantation were not predictors.

Conclusions

Our observations suggest the failure rate after two-stage reimplantation for infected TKA is relatively high. Culture-negative or methicillin-resistant PJI increases the risk of failure over four- and twofold, respectively. We identified no variables that would guide the surgeon in identifying acceptable circumstances in which to perform the second stage.

Level of Evidence

Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgment

We thank Mitchell Maltenfort, PhD, for his assistance with statistical analysis on this project.

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Authors and Affiliations

  1. The Rothman Institute of Orthopaedics at Thomas Jefferson University Hospital, 925 Chestnut Street, 5th Floor, Philadelphia, PA, 19107, USA

    S. M. Javad Mortazavi MD, David Vegari MD, Anthony Ho BA, Benjamin Zmistowski BS & Javad Parvizi MD, FRCS

Authors
  1. S. M. Javad Mortazavi MD
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  2. David Vegari MD
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  3. Anthony Ho BA
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  4. Benjamin Zmistowski BS
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  5. Javad Parvizi MD, FRCS
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Corresponding author

Correspondence to Javad Parvizi MD, FRCS.

Additional information

One or more of the authors (JP) is a consultant for Stryker Orthopaedics (Mahwah, NJ) and has intellectual properties on SmarTech (Philadelphia, PA).

Each author certifies that his or her institution has approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

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Mortazavi, S.M.J., Vegari, D., Ho, A. et al. Two-stage Exchange Arthroplasty for Infected Total Knee Arthroplasty: Predictors of Failure. Clin Orthop Relat Res 469, 3049–3054 (2011). https://doi.org/10.1007/s11999-011-2030-8

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  • DOI: https://doi.org/10.1007/s11999-011-2030-8

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