High infection control rate and function after routine one-stage exchange for chronically infected TKA

Area of Science:

• Orthopedic surgery
• Infectious disease management

Background:

• Two-stage exchange is the standard for chronic infection after total knee arthroplasty (TKA).
• One-stage exchange offers potential benefits but requires further evaluation for infection control and functional outcomes.

Purpose of the Study:

• To compare infection control rates and knee function between one-stage and two-stage exchange for TKA infections.
• To determine if one-stage exchange is a viable alternative to two-stage exchange.

Main Methods:

• Prospective follow-up of 47 patients undergoing one-stage exchange for chronic TKA infection.
• Monitoring for infection recurrence and assessment of Knee Society Scores.
• Minimum 3-year follow-up or until death/recurrence.

Main Results:

• 6% of patients experienced recurrence of the original infection.
• 6% developed a new infection with a different pathogen within 17 months.
• 3-year infection-free survival was 87%; 91% healed of the index infection.
• 56% of patients achieved a Knee Society Score over 150 points.

Conclusions:

• One-stage exchange demonstrated acceptable infection control rates, not significantly worse than two-stage exchange.
• Knee function outcomes were not superior to historical two-stage exchange data.
• One-stage exchange may be a practical, cost-effective alternative, reducing patient burden.
• Further research is needed to identify optimal candidates for one-stage exchange.