Full bibliography

Return to list of results

1.5-Stage Exchange Arthroplasty for Total Knee Arthroplasty Periprosthetic Joint Infections

RIS

Recommended format for most reference management software

BibTeX

Recommended format for BibTeX-specific software

Authors/contributors
Abstract
Background Periprosthetic joint infection (PJI) in total knee arthroplasty (TKA) is a challenging problem. The purpose of this study was to outline a novel technique to treat TKA PJI. We define 1.5-stage exchange arthroplasty as placing an articulating spacer with the intent to last for a prolonged time. Methods A retrospective review was performed from 2007 to 2019 to evaluate patients treated with 1.5-stage exchange arthroplasty for TKA PJI. Inclusion criteria included: articulating knee spacer(s) remaining in situ for 12 months and the patient deferring a second-stage reimplantation because the patient had acceptable function with the spacer (28 knees) or not being a surgical candidate (three knees). Thirty-one knees were included with a mean age of 63 years, mean BMI 34.4 kg/m2, 12 were female, with a mean clinical follow-up of 2.7 years. Cobalt-chrome femoral and polyethylene tibial components were used. We evaluated progression to second-stage reimplantation, reinfection, and radiographic outcomes. Results At a mean follow-up of 2.7 years, 25 initial spacers were in situ (81%). Five knees retained their spacer(s) for some time (mean 1.5 years) and then underwent a second-stage reimplantation; one of the five had progressive radiolucent lines but no evidence of component migration. Three knees (10%) had PJI reoccurrence. Four had progressive radiolucent lines, but there was no evidence of component migration in any knees. Conclusions 1.5-stage exchange arthroplasty may be a reasonable method to treat TKA PJI. At a mean follow-up of 2.7 years, there was an acceptable rate of infection recurrence and implant durability.
Publication
The Journal of Arthroplasty
Date
03/2021
DOI
10.1016/j.arth.2020.09.048
URL
https://linkinghub.elsevier.com/retrieve/pii/S0883540320310597
Notes

Summary:

Key Question: What are the outcomes of using a 1.5-stage exchange arthroplasty approach, with an articulating antibiotic spacer intended for prolonged retention, for treating periprosthetic joint infection (PJI) in total knee arthroplasty (TKA)?

Findings:

  • At mean 2.7 years follow-up, 81% of spacers were still in situ.
  • 16% underwent later reimplantation at mean 1.5 years.
  • 10% had recurrence of PJI requiring reoperation.
  • No evidence of component migration was seen, though some radiolucent lines were present.

Clinical Implications:

  • 1.5-stage exchange, with an articulating spacer retained for a prolonged period, may be a reasonable approach for treating TKA PJI.
  • It had acceptable rates of infection control and component durability in this small case series.

Strengths:

  • Novel approach described
  • Mean 2.7 years follow-up duration
  • Detailed clinical and radiographic outcome reporting

Limitations:

  • Small retrospective case series (only 31 knees)
  • Lack of comparative group or control
  • No patient-reported clinical outcome scores

Level of evidence:

GRADE assessment: Low

Rational: This is a small retrospective case series without controls. There is a lack of high quality comparative data. However, it provides useful preliminary data on this novel approach that can inform future research. The reasonably long mean follow-up and detailed outcomes reporting are strengths, but the small sample size, lack of controls/comparisons, and lack of patient-reported outcomes are limitations that warrant a rating of low quality evidence. This early descriptive data can inform future comparative studies of higher quality.

Citation
1.
Hernandez NM, Buchanan MW, Seyler TM, Wellman SS, Seidelman J, Jiranek WA. 1.5-Stage Exchange Arthroplasty for Total Knee Arthroplasty Periprosthetic Joint Infections. The Journal of Arthroplasty. 2021;36(3):1114-1119.
Section
Link to this record
https://collection.orthoidlibrary.com/bibliography/5DI56P2D