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.
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.
Authors: Kayode O Oduwole; Diarmuid C Molony; Ray J Walls; Simi P Bashir; Kevin J Mulhall Journal: Knee Surg Sports Traumatol Arthrosc Date: 2010-02-11 Impact factor: 4.342
Authors: J Christopher Sherrell; Thomas K Fehring; Susan Odum; Erik Hansen; Benjamin Zmistowski; Anne Dennos; Niraj Kalore Journal: Clin Orthop Relat Res Date: 2011-01 Impact factor: 4.176
Authors: Bernd Kubista; Robert U Hartzler; Christina M Wood; Douglas R Osmon; Arlen D Hanssen; David G Lewallen Journal: Int Orthop Date: 2011-05-07 Impact factor: 3.075
Authors: P Massin; T Delory; L Lhotellier; G Pasquier; O Roche; A Cazenave; C Estellat; J Y Jenny Journal: Knee Surg Sports Traumatol Arthrosc Date: 2015-11-26 Impact factor: 4.342