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Assessing the Gold Standard: A Review of 253 Two-Stage Revisions for Infected TKA

  • Symposium: 2011 Musculoskeletal Infection Society
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Periprosthetic joint infection has been the leading cause of failure following TKA surgery. The gold standard for infection control has been a two-staged revision TKA. There have been few reports on mid- to long-term survivorship, functional outcomes, and fate of patients with a failed two-stage revision TKA.

Questions/purposes

Therefore, we determined (1) the mid-term survivorship of two-stage revision TKA, (2) the function of patients in whom infection was controlled, and (3) the outcome of patients with a failed two-stage revision due to recurrent infection.

Methods

We retrospectively reviewed 239 patients who underwent 253 two-stage revision TKAs for periprosthetic infection. There were 239 patients (253 knees), 104 men and 135 women, with a mean age of 70 ± 10 years at the time of two-stage revision and a mean BMI of 31.53 ± 6.74 kg/m2. During followup, we obtained WOMAC and The Knee Society Clinical Rating Scores and radiographs. The minimum followup was 1 year (median, 4 years; range, 1–17 years).

Results

Thirty-three patients experienced a failed two-staged TKA. Sixteen patients experienced failure due to recurrent sepsis. There were 17 failures for aseptic causes.

Conclusion

The overall infection-free survivorship for two-stage revision TKA was 85% at 5 years and 78% at 10 years.

Level of Evidence

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

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Acknowledgments

The authors thank Dr. Robert B. Bourne for his important contributions to this paper and Lyndsay Somerville for her assistance with extracting data from the database and providing statistical analysis.

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Authors and Affiliations

  1. Division of Orthopaedic Surgery, University of Western Ontario & London Health Sciences Centre, University Campus, 339 Windermere Road, London, ON, N6A 5A5, Canada

    Tahir Mahmud MBBS, FRCS(Tr&Orth), Matthew C. Lyons MBBS, FRACS, Douglas D. Naudie MD, FRCSC, Steven J. MacDonald MD, FRCSC & Richard W. McCalden MD, FRCSC

Authors
  1. Tahir Mahmud MBBS, FRCS(Tr&Orth)
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  2. Matthew C. Lyons MBBS, FRACS
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  3. Douglas D. Naudie MD, FRCSC
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  4. Steven J. MacDonald MD, FRCSC
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  5. Richard W. McCalden MD, FRCSC
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Corresponding author

Correspondence to Tahir Mahmud MBBS, FRCS(Tr&Orth).

Additional information

The institution of all authors has received funding from DePuy (Warsaw, IN, USA), Smith & Nephew (Memphis, TN, USA), and Stryker (Mahwah, NJ, USA). One or more of the authors consults for Smith & Nephew (DDN, RWM) and DePuy (SJM).

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.

Each author certifies that his or her institution has 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.

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Mahmud, T., Lyons, M.C., Naudie, D.D. et al. Assessing the Gold Standard: A Review of 253 Two-Stage Revisions for Infected TKA. Clin Orthop Relat Res 470, 2730–2736 (2012). https://doi.org/10.1007/s11999-012-2358-8

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  • DOI: https://doi.org/10.1007/s11999-012-2358-8

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