Original Article
Single-stage revision for chronic periprosthetic joint infection of the knee: a minimum 4-year follow-up
Abstract
Background: Periprosthetic joint infection (PJI) is one of the most challenging and frequent complications after hip and knee arthroplasty. This study aimed to determine whether chronic PJI patients who had undergone single-stage knee revision: (I) achieved adequate infection control as assessed by culture of synovial fluid and monitoring of inflammatory markers; (II) regained normal knee function as assessed by the Knee Society Score (KSS).
Methods: We retrospectively reviewed 43 patients who had undergone single-stage revision for PJI after total knee arthroplasty (TKA) between April 2005 and October 2011. The most recent follow-up was in October 2014, and the minimum follow-up was 4 years (range, 4–10 years).
Results: Participants were 27 men and 16 women with a mean age of 65 years (range, 37–80 years). Infection was controlled by the time of last follow-up in 41 of 43 patients; one patient died for reasons unrelated to infection after completing the 4-year follow-up, one patient had recurrence of PJI that was eradicated by prosthesis removal and second-stage revision, and one patient had a recurrent fungal infection that was controlled by intravenous vancomycin, intra-articular fluconazole, and oral fluconazole. The mean preoperative KSS score was 33.6 (range, 0–61), which had increased significantly by the last follow-up to 63.9 (range, 43–82) points.
Conclusions: Single-stage revision for chronic knee PJI achieved a high rate of infection control and acceptable functional outcomes; this is a more convenient alternative that avoids the risks associated with two operations and hospitalizations.
Level of Evidence: Level 4, therapeutic study.
Methods: We retrospectively reviewed 43 patients who had undergone single-stage revision for PJI after total knee arthroplasty (TKA) between April 2005 and October 2011. The most recent follow-up was in October 2014, and the minimum follow-up was 4 years (range, 4–10 years).
Results: Participants were 27 men and 16 women with a mean age of 65 years (range, 37–80 years). Infection was controlled by the time of last follow-up in 41 of 43 patients; one patient died for reasons unrelated to infection after completing the 4-year follow-up, one patient had recurrence of PJI that was eradicated by prosthesis removal and second-stage revision, and one patient had a recurrent fungal infection that was controlled by intravenous vancomycin, intra-articular fluconazole, and oral fluconazole. The mean preoperative KSS score was 33.6 (range, 0–61), which had increased significantly by the last follow-up to 63.9 (range, 43–82) points.
Conclusions: Single-stage revision for chronic knee PJI achieved a high rate of infection control and acceptable functional outcomes; this is a more convenient alternative that avoids the risks associated with two operations and hospitalizations.
Level of Evidence: Level 4, therapeutic study.
