Two-stage reimplantation in periprosthetic knee infection

The increasing number of total knee arthroplasties performed yearly worldwide has resulted in a concomitant rise in bacterial infections. Two-stage reimplantation has been reported as the most successful method of treating periprosthetic knee infections. The purpose of this study was to describe all the phases of the two-stage reimplantation and to review the literature regarding the topic.

Most significant and recent papers about the management of periprosthetic knee infection through a two-stage reimplantation protocol were carefully analysed and reviewed. Our personal experience, previously published, with two-stage-reimplantation protocol was also briefly reported.

Two-stage reimplantation has been reported as the most successful method of treating periprosthetic knee infections. The strategy of using an antibiotic-loaded cement spacer and intravenous antibiotics with delayed exchange arthroplasty is actually considered the state-of-the-art, with a reported success rate of 88-96%. The two-stage protocol has been reported as a viable option also for patients with a periprosthetic knee infection by multidrug-resistant organisms. On the other hand, open debridement with polyethylene exchange and single-stage reimplantation have been reported effective only in selective case series involving acute infections by low-virulence organisms.

The strategy that involves the use of cement spacer, intravenous antibiotic therapy, and successive revision total knee implantation is nowadays considered the gold standard for the management of the periprosthetic knee infection. This treatment is actually considered the first choice not only for chronic but also for acute infections, especially in the presence of resistant bacteria.