Rethinking Repeat Two-Stage Knee Exchange Arthroplasty: Outcomes, Risks, and Decision-Making.
Yu-Yi Huang1, Chih-Chien Hu2, Sheng-Hsun Lee2
1Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Keelung Branch, Keelung City, Taiwan; College of Medicine, Chang Gung University (CGU), Kweishan, Taoyuan, Taiwan; Bone and Joint Research Center, Chang Gung Memorial Hospital (CGMH), Kweishan, Taoyuan, Taiwan.
The Journal of Arthroplasty
|January 15, 2025
Summary
Repeat two-stage exchange arthroplasty (EA) for chronic knee periprosthetic joint infection (PJI) shows decreasing success with each attempt. Identifying high-risk patients is crucial for managing expectations and tailoring treatment plans for better outcomes.
Area of Science:
- Orthopedic Surgery
- Infectious Disease Management
- Arthroplasty Outcomes
Background:
- Chronic periprosthetic joint infection (PJI) after knee arthroplasty is a significant clinical challenge.
- Two-stage exchange arthroplasty (EA) is a common treatment, but managing failures and repeat procedures remains complex.
- Limited data exists on the success rates and risk factors associated with repeat EA for knee PJI.
Purpose of the Study:
- To evaluate the outcomes of repeat two-stage EA in patients with chronic knee PJI following initial treatment failure.
- To identify risk factors associated with unsuitability for reimplantation and reinfection after repeat EA.
- To assess the long-term infection-free survival rates for initial, repeat, and re-repeat two-stage EA procedures.
Main Methods:
- A retrospective analysis of 114 patients undergoing repeat EA for chronic knee PJI between 2010 and 2018.
- Patients were selected from an initial cohort of 1,351, with specific exclusion criteria applied.
- Outcomes were assessed using Delphi-based consensus criteria, including wound healing, absence of further interventions, and PJI-related mortality.
Main Results:
- 34.2% of patients were unsuitable for reimplantation due to persistent infection, influenced by comorbidities and shorter intervals between procedures.
- 44.0% of reimplanted patients required further revision for reinfection.
- Five-year infection-free survival rates decreased significantly with repeat procedures: 93% (initial), 72% (repeat), and 43% (re-repeat).
- High rates of rereinfection (39.5%), amputation (12 cases), and mortality (15.8%) were observed in this challenging patient group.
Conclusions:
- First-time two-stage EA for knee PJI demonstrates good efficacy.
- Subsequent repeat two-stage EA procedures are associated with significantly lower success rates and higher complication risks.
- Careful patient selection and realistic outcome expectations are paramount for managing complex knee PJI cases requiring repeat interventions.
