Authors: Azzam K, McHale K., Restrepo C, Purtill J, Parvizi J
Title: Outcome of a Second Two-Stage Reimplantation for Total Knee Arthroplasty Re-Infection
Institution: Rothman Institute, Philadelphia, PA
Purpose: This study aims at measuring the outcome of the second two-stage exchange arthroplasty for infected total knee replacement at a single institution and identifying risk factors for failure.
Methods: Between 1999 and 2005, patients who had reinfection after two-stage reimplantation of total knee arthroplasty were retrospectively reviewed using our institutional database. A subgroup of 18 patients were treated with a second resection-reimplantation protocol. Those patients were followed up prospectively. Demographics, comorbidities, intraoperative data, organism profile, and complications were extracted to evaluate potential outcome predictors.
Results: At an average of 40 months follow-up, 14 patients were infection free accounting to a success rate of 77.8%. Recurrent infection was diagnosed in 4/18 patients (22.2%) after the second two-stage revision, two of which were successfully treated with a third two-stage revision. Knee society score questionnaire administered at the latest follow-up showed excellent results in 7 patients, good in 4 patients, fair in 1 patient and poor results in 4 patients.
Discussion and Conclusion: Recurrence of infection after two-stage exchange arthroplasty for an infected total knee arthroplasty requires aggressive measures to control infection. This study demonstrates that although the functional outcome of a second reimplantation is generally modest, it is still a viable knee-salvage option provided such surgery is only undertaken after strict criteria are met.