Infection recurrence factors in one- and two-stage total knee prosthesis exchanges

Area of Science:

• Orthopedic Surgery
• Infectious Disease Management
• Biomaterials in Orthopedics

Background:

• Infected total knee replacements (TKR) often require revision surgery.
• Current two-stage revision protocols involve a delayed re-implantation with an antibiotic-loaded acrylic spacer.
• One-stage re-implantation offers immediate replacement, but direct comparisons are limited.

Purpose of the Study:

• To compare the efficacy of one-stage versus two-stage surgical approaches for treating infected TKR.
• To investigate the influence of surgical approach on infection recurrence rates.
• To identify factors associated with treatment failure in infected TKR.

Main Methods:

• A retrospective multi-center study included 285 patients with infected TKR treated between 2005 and 2010.
• Patients underwent either one-stage or two-stage re-implantation, with follow-up exceeding 2 years.
• Uni- and multi-variate logistic regression analyzed factors linked to infection recurrence.

Main Results:

• Factors associated with infection recurrence included fistulae, Gram-negative bacterial infections, and two-stage surgery with static spacers.
• A significant interaction between gender and surgical type was observed (p=0.05).
• In women, two-stage surgery with static spacers independently increased recurrence risk (OR 5.9).

Conclusions:

• Two-stage procedures provided less benefit for female patients undergoing infected TKR revision.
• One-stage procedures are preferable for infected TKR, offering comparable outcomes with improved patient comfort.
• Routine one-stage re-implantation may be a viable option for managing infected TKR.