BACKGROUND: A two-stage revision remains the gold standard to eradicate deep infection in total knee arthroplasty. Higher failure rates are associated with a number of factors including poly-microbial infections, multiresistant organisms and previous operations. The aims are to investigate [1] the overall success rate of a two-stage revision for infections in TKA, [2] the outcome of repeat two-stage revisions in recurrent infections and [3] the factors affecting the outcomes of such cases. METHODS: We present the outcomes of a consecutive, retrospective case series of 51 periprosthetic joint infections managed with a two-stage revision knee arthroplasty over a three year period. RESULTS: Forty-six (90%) of 51 were referred from other hospitals. Infection was successfully eradicated in 24 (65%) of 37 patients undergoing an initial two-stage procedure. Following a failed two-stage revision, a repeat two-stage revision was performed in 19 patients eradicating infection in 8 (42%). A third two-stage was performed in five of these patients eradicating infection in three with an average follow-up of 43 months. Multidrug resistance was present in 69%, and 47% of the patients were infected with multiple organisms. All unsuccessful outcomes involved at least one multidrug-resistant organism compared to 43% in the successful cohort (P=0.0002). Serological markers prior to a second-stage procedure were not significantly different between successful and unsuccessful outcome groups. CONCLUSION: Single or multiple two-stage revisions can eradicate infection despite previous failed attempts. In this series, failure is associated with multidrug resistance, previous failed attempts to eradicate infection and a less favourable host response.
BACKGROUND: A two-stage revision remains the gold standard to eradicate deep infection in total knee arthroplasty. Higher failure rates are associated with a number of factors including poly-microbial infections, multiresistant organisms and previous operations. The aims are to investigate [1] the overall success rate of a two-stage revision for infections in TKA, [2] the outcome of repeat two-stage revisions in recurrent infections and [3] the factors affecting the outcomes of such cases. METHODS: We present the outcomes of a consecutive, retrospective case series of 51 periprosthetic joint infections managed with a two-stage revision knee arthroplasty over a three year period. RESULTS: Forty-six (90%) of 51 were referred from other hospitals. Infection was successfully eradicated in 24 (65%) of 37 patients undergoing an initial two-stage procedure. Following a failed two-stage revision, a repeat two-stage revision was performed in 19 patients eradicating infection in 8 (42%). A third two-stage was performed in five of these patients eradicating infection in three with an average follow-up of 43 months. Multidrug resistance was present in 69%, and 47% of the patients were infected with multiple organisms. All unsuccessful outcomes involved at least one multidrug-resistant organism compared to 43% in the successful cohort (P=0.0002). Serological markers prior to a second-stage procedure were not significantly different between successful and unsuccessful outcome groups. CONCLUSION: Single or multiple two-stage revisions can eradicate infection despite previous failed attempts. In this series, failure is associated with multidrug resistance, previous failed attempts to eradicate infection and a less favourable host response.
Authors: Michael Drexler; Tim Dwyer; Paul R T Kuzyk; Yona Kosashvilli; Mansour Abolghasemian; Gilad J Regev; Assaf Kadar; Tal Frenkel Rutenberg; David Backstein Journal: Knee Surg Sports Traumatol Arthrosc Date: 2015-08-14 Impact factor: 4.342
Authors: Si Young Song; Stuart B Goodman; Gina Suh; Andrea K Finlay; James I Huddleston; William J Maloney; Derek F Amanatullah Journal: Clin Orthop Relat Res Date: 2018-10 Impact factor: 4.176
Authors: Eric Gomez-Urena; Rafael J Sierra; Kerryl E Greenwood-Quiantance; Melissa J Karau; James M Steckelberg; Robin Patel Journal: J Clin Microbiol Date: 2019-01-30 Impact factor: 5.948
Authors: Steffen Hoell; Anna Sieweke; Georg Gosheger; Jendrik Hardes; Ralf Dieckmann; Helmut Ahrens; Arne Streitbuerger Journal: J Orthop Surg Res Date: 2016-08-26 Impact factor: 2.359