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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 after revision arthroplasty for infection. Series sorted by publication year.
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Figure 0002: Rates of recurrent and new infections after revision arthroplasty for infection. Series sorted by publication year.

Mentions: The lowest rates of recurrent infection were reported in studies where no spacer was used (0–5%) (Table 2). Also, resterilized prosthesis spacers, articulating PMMA spacers, and one-stage revision groups had low recurrence rates (0–6%, 0–7%, and 0–6%, respectively). No association was seen between type of spacer and the rate of new infections, although in the ball-and-socket spacer series with relatively young patients an exceptionally high number of new infections was reported (31%). The indication for primary arthroplasty (osteoarthritis or other), mean age, or the pathogen idenepsied did not appear to affect the incidence of post-revision infection rates (data not shown). When the series were sorted by the year of publication, a decline in recurrent infection rate was seen in the most recent studies (Figure 2).


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 after revision arthroplasty for infection. Series sorted by publication year.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 0002: Rates of recurrent and new infections after revision arthroplasty for infection. Series sorted by publication year.
Mentions: The lowest rates of recurrent infection were reported in studies where no spacer was used (0–5%) (Table 2). Also, resterilized prosthesis spacers, articulating PMMA spacers, and one-stage revision groups had low recurrence rates (0–6%, 0–7%, and 0–6%, respectively). No association was seen between type of spacer and the rate of new infections, although in the ball-and-socket spacer series with relatively young patients an exceptionally high number of new infections was reported (31%). The indication for primary arthroplasty (osteoarthritis or other), mean age, or the pathogen idenepsied did not appear to affect the incidence of post-revision infection rates (data not shown). When the series were sorted by the year of publication, a decline in recurrent infection rate was seen in the most recent studies (Figure 2).

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