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Outcome of prosthesis exchange for infected knee arthroplasty: the effect of treatment approach.

Jämsen E, Stogiannidis I, Malmivaara A, Pajamäki J, Puolakka T, Konttinen YT - Acta Orthop (2009)

Bottom Line: Lately, good long-term results of direct exchange arthroplasty have been reported.Two-stage exchange is an effective treatment.More experience in one-stage revision is required in order to define its role in the management of infected knee arthroplasties.

View Article: PubMed Central - PubMed

Affiliation: Medical School, University of Tampere, Tampere, Finland.

ABSTRACT

Background and purpose: Two-stage revision remains the gold standard in the treatment of infected knee arthroplasty. Lately, good long-term results of direct exchange arthroplasty have been reported. The purpose of this literature review is to compare the clinical outcome achieved with one-stage revision and two-stage revision with different types of spacers.

Methods: A thorough systematic review of literature was undertaken to idenepsy reports on the treatment alternatives. Papers written in English or including an English abstract, published from 1980 through 2005, and reporting either the success rate in eradication of infection or the clinical status achieved were reviewed. 31 original articles describing the results of 154 one-stage exchange arthoplasties and of 926 two-stage exchange arthoplasties were included. The depth of detail in the description of materials and methods varied markedly, making it impossible to perform a meta-analysis. Instead, a descriptive review of the results is presented.

Results: With a follow-up of 12-122 months, the overall success rate in eradication of infection was 73-100% after one-stage revisions and 82-100% after two-stage revisions. Reinfection rates were the lowest in series where articulating cement spacers were used, though the follow-up was relatively short. Studies using articulating spacers reported the highest average postoperative ranges of motion. Otherwise, no correlations were observed between the clinical outcome and the length of follow-up, the type of revision, or the type of spacer. The clinical outcome (knee scores and range of motion) of the one-stage revisions was no different from that of the two-stage revisions.

Interpretation: Two-stage exchange is an effective treatment. Mobile spacers may further improve the range of motion. More experience in one-stage revision is required in order to define its role in the management of infected knee arthroplasties.

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Rates of recurrent and new infections. Studies sorted by length of follow-up.
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Figure 0001: Rates of recurrent and new infections. Studies sorted by length of follow-up.

Mentions: Success in infection management was analyzed in three ways. Firstly, the total number of infections appearing after treatment was recorded, supplemented by the number of recurrent infections and of new infections (that is, postoperative infections caused by an organism other than the one detected upon treatment). After the index revision, deep knee infection was detected in 0–31% of cases. The treated infections recurred in 0–18% of the cases. The new infection rate varied from 0 to 31%.The length of follow-up did not appear to affect the rate of recurrent infections, but the reports with follow-up of < 4 years had few new infections (Figure 1).


Outcome of prosthesis exchange for infected knee arthroplasty: the effect of treatment approach.

Jämsen E, Stogiannidis I, Malmivaara A, Pajamäki J, Puolakka T, Konttinen YT - Acta Orthop (2009)

Rates of recurrent and new infections. Studies sorted by length of follow-up.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2823239&req=5

Figure 0001: Rates of recurrent and new infections. Studies sorted by length of follow-up.
Mentions: Success in infection management was analyzed in three ways. Firstly, the total number of infections appearing after treatment was recorded, supplemented by the number of recurrent infections and of new infections (that is, postoperative infections caused by an organism other than the one detected upon treatment). After the index revision, deep knee infection was detected in 0–31% of cases. The treated infections recurred in 0–18% of the cases. The new infection rate varied from 0 to 31%.The length of follow-up did not appear to affect the rate of recurrent infections, but the reports with follow-up of < 4 years had few new infections (Figure 1).

Bottom Line: Lately, good long-term results of direct exchange arthroplasty have been reported.Two-stage exchange is an effective treatment.More experience in one-stage revision is required in order to define its role in the management of infected knee arthroplasties.

View Article: PubMed Central - PubMed

Affiliation: Medical School, University of Tampere, Tampere, Finland.

ABSTRACT

Background and purpose: Two-stage revision remains the gold standard in the treatment of infected knee arthroplasty. Lately, good long-term results of direct exchange arthroplasty have been reported. The purpose of this literature review is to compare the clinical outcome achieved with one-stage revision and two-stage revision with different types of spacers.

Methods: A thorough systematic review of literature was undertaken to idenepsy reports on the treatment alternatives. Papers written in English or including an English abstract, published from 1980 through 2005, and reporting either the success rate in eradication of infection or the clinical status achieved were reviewed. 31 original articles describing the results of 154 one-stage exchange arthoplasties and of 926 two-stage exchange arthoplasties were included. The depth of detail in the description of materials and methods varied markedly, making it impossible to perform a meta-analysis. Instead, a descriptive review of the results is presented.

Results: With a follow-up of 12-122 months, the overall success rate in eradication of infection was 73-100% after one-stage revisions and 82-100% after two-stage revisions. Reinfection rates were the lowest in series where articulating cement spacers were used, though the follow-up was relatively short. Studies using articulating spacers reported the highest average postoperative ranges of motion. Otherwise, no correlations were observed between the clinical outcome and the length of follow-up, the type of revision, or the type of spacer. The clinical outcome (knee scores and range of motion) of the one-stage revisions was no different from that of the two-stage revisions.

Interpretation: Two-stage exchange is an effective treatment. Mobile spacers may further improve the range of motion. More experience in one-stage revision is required in order to define its role in the management of infected knee arthroplasties.

Show MeSH
Related in: MedlinePlus