Do not exchange the spacer during staged TKA exchange!

Area of Science:

• Orthopedic Surgery
• Infectious Diseases

Background:

• Chronic periprosthetic joint infections (PJI) are a significant complication following total knee arthroplasty.
• Two-stage exchange is a common surgical strategy for managing chronic PJI.

Purpose of the Study:

• To determine the reinfection rate and identify risk factors for septic failure after two-stage exchange for PJI in primary total knee arthroplasties.
• To classify reinfections as either new infections or recurrence of the original infection.

Main Methods:

• Retrospective study of 60 knees with chronic PJI.
• Data collected from electronic medical records.
• Mean follow-up of 35.6 months.

Main Results:

• Overall reinfection rate was 20.0%.
• Spacer exchange during the two-stage procedure was the only significant risk factor for reinfection (OR = 10.42, p = 0.001).
• Of 12 reinfections, 6 were new infections and 2 were recurrences.

Conclusions:

• Patient-specific risk factors for reinfection after two-stage exchange remain unclear.
• Performing spacer exchange during the two-stage procedure increases the risk of reinfection.
• The benefit of spacer exchange is questionable, as reinfections are more likely to be new infections than recurrences.