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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 10/2016

01-10-2016 | Knee

Infection recurrence factors in one- and two-stage total knee prosthesis exchanges

Authors: P. Massin, T. Delory, L. Lhotellier, G. Pasquier, O. Roche, A. Cazenave, C. Estellat, J. Y. Jenny

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 10/2016

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Abstract

Purpose

Revision of infected total knee replacements (TKR) is usually delayed for a period in which the joint space is filled with an antibiotic-loaded acrylic spacer. In contrast, one-stage re-implantation supposes immediate re-implantation. Formal comparisons between the two methods are scarce. A retrospective multi-centre study was conducted to investigate the effects of surgery type (one-stage vs. two-stage) on cure rates. It was hypothesised that this parameter would not influence the results.

Method

All infected TKR, treated consecutively between 2005 and 2010 by senior surgeons working in six referral hospitals, were included retrospectively. Two hundred and eighty-five patients, undergoing one-stage or two-stage TKR, with more than 2-year follow-up (clinical and radiological) were eligible for data collection and analysis. Of them, 108 underwent one-stage and 177 received two-stage TKR. Failure was defined as infection recurrence or persistence of the same or unknown pathogens. Factors linked with infection recurrence were analysed by uni- and multi-variate logistic regression with random intercept.

Results

Factors associated with infection recurrence were fistulae (odds ratio (OR) 3.4 [1.2–10.2], p = 0.03), infection by gram-negative bacteria (OR 3.3 [1.0–10.6], p = 0.05), and two-stage surgery with static spacers (OR 4.4 [1.1–17.9], p = 0.04). Gender and type of surgery interacted (p = 0.05). In men (133 patients), type of surgery showed no significant linkage with infection recurrence. In women (152 patients), two-stage surgery with static spacers was associated independently with infection recurrence (OR 5.9 [1.5–23.6], p = 0.01). Among patients without infection recurrence, International Knee Society scores were similar between those undergoing one-stage or two-stage exchanges.

Conclusion

Two-stage procedures offered less benefit to female patients. It suggests that one-stage procedures are preferable, because they offer greater comfort without increasing the risk of recurrence. Routine one-stage procedures may be a reasonable option in the treatment of infected TKR.

Level of evidence

III.
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Metadata
Title
Infection recurrence factors in one- and two-stage total knee prosthesis exchanges
Authors
P. Massin
T. Delory
L. Lhotellier
G. Pasquier
O. Roche
A. Cazenave
C. Estellat
J. Y. Jenny
Publication date
01-10-2016
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 10/2016
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-015-3884-1

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