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Results of ‘two-in-one’ single-stage revision total knee arthroplasty for infection with associated bone loss: prospective five-year follow up
AIMS: Periprosthetic joint infection (PJI) occurs in approximately 1% to 2% of total knee arthroplasties (TKA) presenting multiple challenges, such as difficulty in diagnosis, technical complexity, and financial costs. Two-stage exchange is the gold standard for treating PJI but emerging evidence su...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
The British Editorial Society of Bone & Joint Surgery
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8886320/ https://www.ncbi.nlm.nih.gov/pubmed/35109666 http://dx.doi.org/10.1302/2633-1462.32.BJO-2021-0148.R1 |
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author | Brunt, Andrew C. C. Gillespie, Matthew Holland, George Brenkel, Ivan Walmsley, Phil |
author_facet | Brunt, Andrew C. C. Gillespie, Matthew Holland, George Brenkel, Ivan Walmsley, Phil |
author_sort | Brunt, Andrew C. C. |
collection | PubMed |
description | AIMS: Periprosthetic joint infection (PJI) occurs in approximately 1% to 2% of total knee arthroplasties (TKA) presenting multiple challenges, such as difficulty in diagnosis, technical complexity, and financial costs. Two-stage exchange is the gold standard for treating PJI but emerging evidence suggests 'two-in-one' single-stage revision as an alternative, delivering comparable outcomes, reduced morbidity, and cost-effectiveness. This study investigates five-year results of modified single-stage revision for treatment of PJI following TKA with bone loss. METHODS: Patients were identified from prospective data on all TKA patients with PJI following the primary procedure. Inclusion criteria were: revision for PJI with bone loss requiring reconstruction, and a minimum five years’ follow-up. Patients were followed up for recurrent infection and assessment of function. Tools used to assess function were Oxford Knee Score (OKS) and American Knee Society Score (AKSS). RESULTS: A total of 24 patients were included with a mean age of 72.7 years (SD 7.6), mean BMI of 33.3 kg/m(2) (SD 5.7), and median ASA grade of 2 (interquartile range 2 to 4). Mean time from primary to revision was 3.0 years (10 months to 8.3 years). At revision, six patients had discharging sinus and three patients had negative cultures from tissue samples or aspirates. Two patients developed recurrence of infection: one was treated successfully with antibiotic suppression and one underwent debridement, antibiotics, and implant retention. Mean AKSS scores at two years showed significant improvement from baseline (27.1 (SD 10.2 ) vs 80.3 (SD 14.8); p < 0.001). There was no significant change in mean AKSS scores between two and five years (80.3 (SD 14.8 ) vs 74.1 (SD 19.8); p = 0.109). Five-year OKS scores were not significantly different compared to two-year scores (36.17 (SD 3.7) vs 33.0 (SD 8.5); p = 0.081). CONCLUSION: ‘Two-in-one’ single-stage revision is effective for treating PJI following TKA with bone loss, providing patients with sustained improvements in outcomes and infection clearance up to five years post-procedure. Cite this article: Bone Jt Open 2022;3(2):107–113. |
format | Online Article Text |
id | pubmed-8886320 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | The British Editorial Society of Bone & Joint Surgery |
record_format | MEDLINE/PubMed |
spelling | pubmed-88863202022-03-17 Results of ‘two-in-one’ single-stage revision total knee arthroplasty for infection with associated bone loss: prospective five-year follow up Brunt, Andrew C. C. Gillespie, Matthew Holland, George Brenkel, Ivan Walmsley, Phil Bone Jt Open Knee AIMS: Periprosthetic joint infection (PJI) occurs in approximately 1% to 2% of total knee arthroplasties (TKA) presenting multiple challenges, such as difficulty in diagnosis, technical complexity, and financial costs. Two-stage exchange is the gold standard for treating PJI but emerging evidence suggests 'two-in-one' single-stage revision as an alternative, delivering comparable outcomes, reduced morbidity, and cost-effectiveness. This study investigates five-year results of modified single-stage revision for treatment of PJI following TKA with bone loss. METHODS: Patients were identified from prospective data on all TKA patients with PJI following the primary procedure. Inclusion criteria were: revision for PJI with bone loss requiring reconstruction, and a minimum five years’ follow-up. Patients were followed up for recurrent infection and assessment of function. Tools used to assess function were Oxford Knee Score (OKS) and American Knee Society Score (AKSS). RESULTS: A total of 24 patients were included with a mean age of 72.7 years (SD 7.6), mean BMI of 33.3 kg/m(2) (SD 5.7), and median ASA grade of 2 (interquartile range 2 to 4). Mean time from primary to revision was 3.0 years (10 months to 8.3 years). At revision, six patients had discharging sinus and three patients had negative cultures from tissue samples or aspirates. Two patients developed recurrence of infection: one was treated successfully with antibiotic suppression and one underwent debridement, antibiotics, and implant retention. Mean AKSS scores at two years showed significant improvement from baseline (27.1 (SD 10.2 ) vs 80.3 (SD 14.8); p < 0.001). There was no significant change in mean AKSS scores between two and five years (80.3 (SD 14.8 ) vs 74.1 (SD 19.8); p = 0.109). Five-year OKS scores were not significantly different compared to two-year scores (36.17 (SD 3.7) vs 33.0 (SD 8.5); p = 0.081). CONCLUSION: ‘Two-in-one’ single-stage revision is effective for treating PJI following TKA with bone loss, providing patients with sustained improvements in outcomes and infection clearance up to five years post-procedure. Cite this article: Bone Jt Open 2022;3(2):107–113. The British Editorial Society of Bone & Joint Surgery 2022-02-03 /pmc/articles/PMC8886320/ /pubmed/35109666 http://dx.doi.org/10.1302/2633-1462.32.BJO-2021-0148.R1 Text en © 2022 Author(s) et al. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives (CC BY-NC-ND 4.0) licence, which permits the copying and redistribution of the work only, and provided the original author and source are credited. See https://creativecommons.org/licenses/by-nc-nd/4.0/ |
spellingShingle | Knee Brunt, Andrew C. C. Gillespie, Matthew Holland, George Brenkel, Ivan Walmsley, Phil Results of ‘two-in-one’ single-stage revision total knee arthroplasty for infection with associated bone loss: prospective five-year follow up |
title | Results of ‘two-in-one’ single-stage revision total knee arthroplasty for infection with associated bone loss: prospective five-year follow up |
title_full | Results of ‘two-in-one’ single-stage revision total knee arthroplasty for infection with associated bone loss: prospective five-year follow up |
title_fullStr | Results of ‘two-in-one’ single-stage revision total knee arthroplasty for infection with associated bone loss: prospective five-year follow up |
title_full_unstemmed | Results of ‘two-in-one’ single-stage revision total knee arthroplasty for infection with associated bone loss: prospective five-year follow up |
title_short | Results of ‘two-in-one’ single-stage revision total knee arthroplasty for infection with associated bone loss: prospective five-year follow up |
title_sort | results of ‘two-in-one’ single-stage revision total knee arthroplasty for infection with associated bone loss: prospective five-year follow up |
topic | Knee |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8886320/ https://www.ncbi.nlm.nih.gov/pubmed/35109666 http://dx.doi.org/10.1302/2633-1462.32.BJO-2021-0148.R1 |
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