Cargando…

Detailed Revision Risk Analysis after Single- vs. Two-Stage Revision Total Knee Arthroplasty in Periprosthetic Joint Infection: A Retrospective Tertiary Center Analysis

Periprosthetic joint infection (PJI) remains one of the most common causes of revision knee arthroplasty. Controversy continues to surround the proper operative technique of PJI in knee arthroplasty with single- or two-stage replacement. Significant variations are seen in the eradication rates of PJ...

Descripción completa

Detalles Bibliográficos
Autores principales: Tuecking, Lars-Rene, Silligmann, Julia, Savov, Peter, Omar, Mohamed, Windhagen, Henning, Ettinger, Max
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8533002/
https://www.ncbi.nlm.nih.gov/pubmed/34680758
http://dx.doi.org/10.3390/antibiotics10101177
_version_ 1784587207399440384
author Tuecking, Lars-Rene
Silligmann, Julia
Savov, Peter
Omar, Mohamed
Windhagen, Henning
Ettinger, Max
author_facet Tuecking, Lars-Rene
Silligmann, Julia
Savov, Peter
Omar, Mohamed
Windhagen, Henning
Ettinger, Max
author_sort Tuecking, Lars-Rene
collection PubMed
description Periprosthetic joint infection (PJI) remains one of the most common causes of revision knee arthroplasty. Controversy continues to surround the proper operative technique of PJI in knee arthroplasty with single- or two-stage replacement. Significant variations are seen in the eradication rates of PJI and in implant survival rates. This detailed retrospective analysis of a single tertiary center is intended to provide further data and insight comparing single- and two-stage revision surgery. A retrospective analysis of all revision total knee arthroplasty (TKA) surgeries from 2013 to 2019 was performed and screened with respect to single- or two-stage TKA revisions. Single- and two-stage revisions were analyzed with regard to implant survival, revision rate, microbiological spectrum, and other typical demographic characteristics. A total of 63 patients were included, with 15 patients undergoing single-stage revision and 48 patients undergoing two-stage revision. The mean follow-up time was 40.7 to 43.7 months. Statistically, no difference was found between both groups in overall survival (54.4% vs. 70.1%, p = 0.68) and implant survival with respect to reinfection (71.4% vs. 82.4%, p = 0.48). Further, high reinfection rates were found for patients with difficult-to-treat organisms and low- to semi-constrained implant types, in comparison to constrained implant types. A statistically comparable revision rate for recurrence of infection could be shown for both groups, although a tendency to higher reinfection rate for single-stage change was evident. The revision rate in this single-center study was comparably high, which could be caused by the high comorbidity and high proportion of difficult-to-treat bacteria in patients at a tertiary center. In this patient population, the expectation of implant survival should be critically discussed with patients.
format Online
Article
Text
id pubmed-8533002
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-85330022021-10-23 Detailed Revision Risk Analysis after Single- vs. Two-Stage Revision Total Knee Arthroplasty in Periprosthetic Joint Infection: A Retrospective Tertiary Center Analysis Tuecking, Lars-Rene Silligmann, Julia Savov, Peter Omar, Mohamed Windhagen, Henning Ettinger, Max Antibiotics (Basel) Article Periprosthetic joint infection (PJI) remains one of the most common causes of revision knee arthroplasty. Controversy continues to surround the proper operative technique of PJI in knee arthroplasty with single- or two-stage replacement. Significant variations are seen in the eradication rates of PJI and in implant survival rates. This detailed retrospective analysis of a single tertiary center is intended to provide further data and insight comparing single- and two-stage revision surgery. A retrospective analysis of all revision total knee arthroplasty (TKA) surgeries from 2013 to 2019 was performed and screened with respect to single- or two-stage TKA revisions. Single- and two-stage revisions were analyzed with regard to implant survival, revision rate, microbiological spectrum, and other typical demographic characteristics. A total of 63 patients were included, with 15 patients undergoing single-stage revision and 48 patients undergoing two-stage revision. The mean follow-up time was 40.7 to 43.7 months. Statistically, no difference was found between both groups in overall survival (54.4% vs. 70.1%, p = 0.68) and implant survival with respect to reinfection (71.4% vs. 82.4%, p = 0.48). Further, high reinfection rates were found for patients with difficult-to-treat organisms and low- to semi-constrained implant types, in comparison to constrained implant types. A statistically comparable revision rate for recurrence of infection could be shown for both groups, although a tendency to higher reinfection rate for single-stage change was evident. The revision rate in this single-center study was comparably high, which could be caused by the high comorbidity and high proportion of difficult-to-treat bacteria in patients at a tertiary center. In this patient population, the expectation of implant survival should be critically discussed with patients. MDPI 2021-09-27 /pmc/articles/PMC8533002/ /pubmed/34680758 http://dx.doi.org/10.3390/antibiotics10101177 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Tuecking, Lars-Rene
Silligmann, Julia
Savov, Peter
Omar, Mohamed
Windhagen, Henning
Ettinger, Max
Detailed Revision Risk Analysis after Single- vs. Two-Stage Revision Total Knee Arthroplasty in Periprosthetic Joint Infection: A Retrospective Tertiary Center Analysis
title Detailed Revision Risk Analysis after Single- vs. Two-Stage Revision Total Knee Arthroplasty in Periprosthetic Joint Infection: A Retrospective Tertiary Center Analysis
title_full Detailed Revision Risk Analysis after Single- vs. Two-Stage Revision Total Knee Arthroplasty in Periprosthetic Joint Infection: A Retrospective Tertiary Center Analysis
title_fullStr Detailed Revision Risk Analysis after Single- vs. Two-Stage Revision Total Knee Arthroplasty in Periprosthetic Joint Infection: A Retrospective Tertiary Center Analysis
title_full_unstemmed Detailed Revision Risk Analysis after Single- vs. Two-Stage Revision Total Knee Arthroplasty in Periprosthetic Joint Infection: A Retrospective Tertiary Center Analysis
title_short Detailed Revision Risk Analysis after Single- vs. Two-Stage Revision Total Knee Arthroplasty in Periprosthetic Joint Infection: A Retrospective Tertiary Center Analysis
title_sort detailed revision risk analysis after single- vs. two-stage revision total knee arthroplasty in periprosthetic joint infection: a retrospective tertiary center analysis
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8533002/
https://www.ncbi.nlm.nih.gov/pubmed/34680758
http://dx.doi.org/10.3390/antibiotics10101177
work_keys_str_mv AT tueckinglarsrene detailedrevisionriskanalysisaftersinglevstwostagerevisiontotalkneearthroplastyinperiprostheticjointinfectionaretrospectivetertiarycenteranalysis
AT silligmannjulia detailedrevisionriskanalysisaftersinglevstwostagerevisiontotalkneearthroplastyinperiprostheticjointinfectionaretrospectivetertiarycenteranalysis
AT savovpeter detailedrevisionriskanalysisaftersinglevstwostagerevisiontotalkneearthroplastyinperiprostheticjointinfectionaretrospectivetertiarycenteranalysis
AT omarmohamed detailedrevisionriskanalysisaftersinglevstwostagerevisiontotalkneearthroplastyinperiprostheticjointinfectionaretrospectivetertiarycenteranalysis
AT windhagenhenning detailedrevisionriskanalysisaftersinglevstwostagerevisiontotalkneearthroplastyinperiprostheticjointinfectionaretrospectivetertiarycenteranalysis
AT ettingermax detailedrevisionriskanalysisaftersinglevstwostagerevisiontotalkneearthroplastyinperiprostheticjointinfectionaretrospectivetertiarycenteranalysis