Single-stage revision for the infected total knee replacement: results from a single centre

• Published in: The bone & joint journal Vol. 96-B; no. 6; pp. 759 - 764
• Main Authors: Tibrewal, S, Malagelada, F, Jeyaseelan, L, Posch, F, Scott, G
• Format: Journal Article
• Language: English
• Published: England 01.06.2014
• Subjects: Adult; Aged; Aged, 80 and over; Antibiotic Prophylaxis - methods; Arthroplasty, Replacement, Knee - adverse effects; Arthroplasty, Replacement, Knee - methods; Cohort Studies; Confidence Intervals; Debridement - methods; Device Removal - methods; Female; Follow-Up Studies; Humans; Kaplan-Meier Estimate; Knee Prosthesis; Male; Middle Aged; Osteoarthritis, Knee - diagnostic imaging; Osteoarthritis, Knee - surgery; Prosthesis Design; Prosthesis Failure; Prosthesis-Related Infections - diagnostic imaging; Prosthesis-Related Infections - drug therapy; Prosthesis-Related Infections - surgery; Radiography; Reoperation - methods; Retrospective Studies; Risk Assessment; Treatment Outcome; Revision TKR; Infected TKR; Single stage revision
• ISSN: 2049-4394; 2049-4408
• DOI: 10.1302/0301-620X.96B6.33086

Peri-prosthetic infection is amongst the most common causes of failure following total knee replacement (TKR). In the presence of established infection, thorough joint debridement and removal of all components is necessary following which new components may be implanted. This can be performed in one or two stages; two-stage revision with placement of an interim antibiotic-loaded spacer is regarded by many to be the standard procedure for eradication of peri-prosthetic joint infection. We present our experience of a consecutive series of 50 single-stage revision TKRs for established deep infection performed between 1979 and 2010. There were 33 women and 17 men with a mean age at revision of 66.8 years (42 to 84) and a mean follow-up of 10.5 years (2 to 24). The mean time between the primary TKR and the revision procedure was 2.05 years (1 to 8). Only one patient required a further revision for recurrent infection, representing a success rate of 98%. Nine patients required further revision for aseptic loosening, according to microbiological testing of biopsies taken at the subsequent surgery. Three other patients developed a further septic episode but none required another revision. These results suggest that a single-stage revision can produce comparable results to a two-stage revision. Single-stage revision offers a reduction in costs as well as less morbidity and inconvenience for patients.