J Bone Jt Infect 2020; 5(3):137-144. doi:10.7150/jbji.43705
Reinfection and re-revision rates of 113 two-stage revisions in infected TKA
1. Department of Orthopaedic Surgery, Prosthetic Joint Infection Unit, Sint Maartenskliniek, Nijmegen, the Netherlands
2. Sint Maartenskliniek Research, Sint Maartenskliniek, Nijmegen, the Netherlands
Bongers J, Jacobs AME, Smulders K, van Hellemondt GG, Goosen JHM. Reinfection and re-revision rates of 113 two-stage revisions in infected TKA. J Bone Jt Infect 2020; 5(3):137-144. doi:10.7150/jbji.43705. Available from http://www.jbji.net/v05p0137.htm
Introduction: Two-stage revision is the most frequently performed revision procedure of a (suspected) periprosthetic joint infection (PJI) after total knee arthroplasty (TKA). The reported results of this treatment show large variability between studies, ranging between 0 - 40 percent failure. The purposes of this study were to determine long term (1) reinfection rate, (2) re-revision rates for any reason, and (3) the reinfection rate of patients with positive cultures at reimplantation.
Methods: We prospectively followed and retrospectively reviewed 113 consecutive two-stage revision TKAs, performed between 2003 and 2013 in our clinic with a minimum follow-up of 2 years. Diagnosis of PJI was based on the major Musculoskeletal Infection Society criteria for PJI.
Results: After a mean follow-up of 94 months (range 24-172 months), infection recurred in 23 cases (23%). Of these, nine cases (9%) were defined as relapse (same micro-organism as index revision) and in 14 cases another causative was found (14%). In 11 patients debridement, antibiotics and retention of the prosthesis successfully eradicated the reinfection. After overall follow-up 17 patients (17%) underwent re-revision surgery, 11 patients (11%) due to an infection and 6 patients (6%) for aseptic reasons.
Conclusions: Treatment of a (suspected) infection of a TKA by a two-stage revision had acceptable results based on re-revision and re-infection rates in the long term (>5 years), resembling the short-term results (<2 years). Focussing on the cultures at the index two-stage revision, episodes of relapse and new infections during follow-up were almost equally divided. Reinfection rates were higher in cases with positive cultures at reimplantation. Patients should be counselled appropriately in this particular situation.