High revision rates following repeat septic revision after failed one-stage exchange for periprosthetic joint infection in total knee arthroplasty. (1st March 2022)

• Record Type: Journal Article
• Authors: Neufeld, Michael E.; Liechti, Emanuel F.; Soto, Fernando; Linke, Philip; Busch, Sophia-Marlene; Gehrke, Thorsten; Citak, Mustafa
• Is Part Of: Bone & joint journal. Volume 104B:Number 3(2022)
• Page Start: 386
• Page End: 393
• Publication Date: 2022-03-01
• Subjects: Failed one-stage exchange arthroplasty -- Repeat septic revision -- Periprosthetic joint infection -- Revision total knee arthroplasty -- Outcomes -- Survival -- total knee arthroplasty (TKA) -- Periprosthetic joint infection (PJI) -- infections -- Musculoskeletal Infection -- revision TKAs -- antibiotics -- debridement -- organism(s) -- knees -- reoperation; Bones -- Surgery -- Periodicals; Joints -- Surgery -- Periodicals; Orthopedic surgery -- Periodicals; 617.47005
• DOI: 10.1302/0301-620X.104B3.BJJ-2021-0481.R2
• Languages: English
• ISSNs: 2049-4394

Abstract

Abstract : Aims: The outcome of repeat septic revision after a failed one-stage exchange for periprosthetic joint infection (PJI) in total knee arthroplasty (TKA) remains unknown. The aim of this study was to report the infection-free and all-cause revision-free survival of repeat septic revision after a failed one-stage exchange, and to determine whether the Musculoskeletal Infection Society (MSIS) stage is associated with subsequent infection-related failure. Methods: We retrospectively reviewed all repeat septic revision TKAs which were undertaken after a failed one-stage exchange between 2004 and 2017. A total of 33 repeat septic revisions (29 one-stage and four two-stage) met the inclusion criteria. The mean follow-up from repeat septic revision was 68.2 months (8.0 months to 16.1 years). The proportion of patients who had a subsequent infection-related failure and all-cause revision was reported and Kaplan-Meier survival for these endpoints was determined. Patients were categorized according to the MSIS staging system, and the association with subsequent infection was analyzed. Results: At the most recent follow-up, 17 repeat septic revisions (52%) had a subsequent infection-related failure and the five-year infection-free survival was 59% (95% confidence interval (CI) 39 to 74). A total of 19 underwent a subsequent all-cause revision (58%) and the five-year all-cause revision-free survival was 47% (95% CI 28 to 64). The most common indication for the first subsequent aseptic revision was loosening. The MSIS stage of the host status (p = 0.663) and limb status (p = 1.000) were not significantly associated with subsequent infection-related failure. Conclusion: Repeat septic revision after a failed one-stage exchange TKA for PJI is associated with a high rate of subsequent infection-related failure and all-cause revision. Patients should be counselled appropriately to manage expectations. The host and limb status according to the MSIS staging system were not associated with subsequent infection-related failure. Cite this article: Bone Joint J 2022;104-B(3):386–393.