Results of ‘two-in-one’ single-stage revision total knee arthroplasty for infection with associated bone loss <subtitle>prospective five-year follow up</subtitle>
Aims Periprosthetic joint infection (PJI) occurs in approximately 1% to 2% of total knee arthroplasties (TKA) presenting multiple challenges, such as difficulty in diagnosis, technical complexity, and financial costs. Two-stage exchange is the gold standard for treating PJI but emerging evidence sug...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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The British Editorial Society of Bone & Joint Surgery
2022-02-01
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| Series: | Bone & Joint Open |
| Subjects: | |
| Online Access: | https://online.boneandjoint.org.uk/doi/10.1302/2633-1462.32.BJO-2021-0148.R1 |
| _version_ | 1828544238351024128 |
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| author | Andrew C. C. Brunt Matthew Gillespie George Holland Ivan Brenkel Phil Walmsley |
| author_facet | Andrew C. C. Brunt Matthew Gillespie George Holland Ivan Brenkel Phil Walmsley |
| author_sort | Andrew C. C. Brunt |
| collection | DOAJ |
| description | Aims Periprosthetic joint infection (PJI) occurs in approximately 1% to 2% of total knee arthroplasties (TKA) presenting multiple challenges, such as difficulty in diagnosis, technical complexity, and financial costs. Two-stage exchange is the gold standard for treating PJI but emerging evidence suggests 'two-in-one' single-stage revision as an alternative, delivering comparable outcomes, reduced morbidity, and cost-effectiveness. This study investigates five-year results of modified single-stage revision for treatment of PJI following TKA with bone loss. Methods Patients were identified from prospective data on all TKA patients with PJI following the primary procedure. Inclusion criteria were: revision for PJI with bone loss requiring reconstruction, and a minimum five years’ follow-up. Patients were followed up for recurrent infection and assessment of function. Tools used to assess function were Oxford Knee Score (OKS) and American Knee Society Score (AKSS). Results A total of 24 patients were included with a mean age of 72.7 years (SD 7.6), mean BMI of 33.3 kg/m2 (SD 5.7), and median ASA grade of 2 (interquartile range 2 to 4). Mean time from primary to revision was 3.0 years (10 months to 8.3 years). At revision, six patients had discharging sinus and three patients had negative cultures from tissue samples or aspirates. Two patients developed recurrence of infection: one was treated successfully with antibiotic suppression and one underwent debridement, antibiotics, and implant retention. Mean AKSS scores at two years showed significant improvement from baseline (27.1 (SD 10.2 ) vs 80.3 (SD 14.8); p < 0.001). There was no significant change in mean AKSS scores between two and five years (80.3 (SD 14.8 ) vs 74.1 (SD 19.8); p = 0.109). Five-year OKS scores were not significantly different compared to two-year scores (36.17 (SD 3.7) vs 33.0 (SD 8.5); p = 0.081). Conclusion ‘Two-in-one’ single-stage revision is effective for treating PJI following TKA with bone loss, providing patients with sustained improvements in outcomes and infection clearance up to five years post-procedure. Cite this article: Bone Jt Open 2022;3(2):107–113. |
| first_indexed | 2024-12-12T02:27:32Z |
| format | Article |
| id | doaj.art-149f33db306d47e4a0f652a941563dc1 |
| institution | Directory Open Access Journal |
| issn | 2633-1462 |
| language | English |
| last_indexed | 2024-12-12T02:27:32Z |
| publishDate | 2022-02-01 |
| publisher | The British Editorial Society of Bone & Joint Surgery |
| record_format | Article |
| series | Bone & Joint Open |
| spelling | doaj.art-149f33db306d47e4a0f652a941563dc12022-12-22T00:41:31ZengThe British Editorial Society of Bone & Joint SurgeryBone & Joint Open2633-14622022-02-013210711310.1302/2633-1462.32.BJO-2021-0148.R1Results of ‘two-in-one’ single-stage revision total knee arthroplasty for infection with associated bone loss <subtitle>prospective five-year follow up</subtitle>Andrew C. C. Brunt0Matthew Gillespie1George Holland2Ivan Brenkel3Phil Walmsley4Department of Orthpaedic Surgery, Victoria Hospital Kirkcaldy, Kirkcaldy, UKDepartment of Orthpaedic Surgery, Victoria Hospital Kirkcaldy, Kirkcaldy, UKDepartment of Orthpaedic Surgery, Victoria Hospital Kirkcaldy, Kirkcaldy, UKDepartment of Orthpaedic Surgery, Victoria Hospital Kirkcaldy, Kirkcaldy, UKDepartment of Orthpaedic Surgery, Victoria Hospital Kirkcaldy, Kirkcaldy, UKAims Periprosthetic joint infection (PJI) occurs in approximately 1% to 2% of total knee arthroplasties (TKA) presenting multiple challenges, such as difficulty in diagnosis, technical complexity, and financial costs. Two-stage exchange is the gold standard for treating PJI but emerging evidence suggests 'two-in-one' single-stage revision as an alternative, delivering comparable outcomes, reduced morbidity, and cost-effectiveness. This study investigates five-year results of modified single-stage revision for treatment of PJI following TKA with bone loss. Methods Patients were identified from prospective data on all TKA patients with PJI following the primary procedure. Inclusion criteria were: revision for PJI with bone loss requiring reconstruction, and a minimum five years’ follow-up. Patients were followed up for recurrent infection and assessment of function. Tools used to assess function were Oxford Knee Score (OKS) and American Knee Society Score (AKSS). Results A total of 24 patients were included with a mean age of 72.7 years (SD 7.6), mean BMI of 33.3 kg/m2 (SD 5.7), and median ASA grade of 2 (interquartile range 2 to 4). Mean time from primary to revision was 3.0 years (10 months to 8.3 years). At revision, six patients had discharging sinus and three patients had negative cultures from tissue samples or aspirates. Two patients developed recurrence of infection: one was treated successfully with antibiotic suppression and one underwent debridement, antibiotics, and implant retention. Mean AKSS scores at two years showed significant improvement from baseline (27.1 (SD 10.2 ) vs 80.3 (SD 14.8); p < 0.001). There was no significant change in mean AKSS scores between two and five years (80.3 (SD 14.8 ) vs 74.1 (SD 19.8); p = 0.109). Five-year OKS scores were not significantly different compared to two-year scores (36.17 (SD 3.7) vs 33.0 (SD 8.5); p = 0.081). Conclusion ‘Two-in-one’ single-stage revision is effective for treating PJI following TKA with bone loss, providing patients with sustained improvements in outcomes and infection clearance up to five years post-procedure. Cite this article: Bone Jt Open 2022;3(2):107–113.https://online.boneandjoint.org.uk/doi/10.1302/2633-1462.32.BJO-2021-0148.R1ArthroplastyInfectionRevisionKneeBone lossrevision total knee arthroplasty (TKA) |
| spellingShingle | Andrew C. C. Brunt Matthew Gillespie George Holland Ivan Brenkel Phil Walmsley Results of ‘two-in-one’ single-stage revision total knee arthroplasty for infection with associated bone loss <subtitle>prospective five-year follow up</subtitle> Bone & Joint Open Arthroplasty Infection Revision Knee Bone loss revision total knee arthroplasty (TKA) |
| title | Results of ‘two-in-one’ single-stage revision total knee arthroplasty for infection with associated bone loss <subtitle>prospective five-year follow up</subtitle> |
| title_full | Results of ‘two-in-one’ single-stage revision total knee arthroplasty for infection with associated bone loss <subtitle>prospective five-year follow up</subtitle> |
| title_fullStr | Results of ‘two-in-one’ single-stage revision total knee arthroplasty for infection with associated bone loss <subtitle>prospective five-year follow up</subtitle> |
| title_full_unstemmed | Results of ‘two-in-one’ single-stage revision total knee arthroplasty for infection with associated bone loss <subtitle>prospective five-year follow up</subtitle> |
| title_short | Results of ‘two-in-one’ single-stage revision total knee arthroplasty for infection with associated bone loss <subtitle>prospective five-year follow up</subtitle> |
| title_sort | results of two in one single stage revision total knee arthroplasty for infection with associated bone loss subtitle prospective five year follow up subtitle |
| topic | Arthroplasty Infection Revision Knee Bone loss revision total knee arthroplasty (TKA) |
| url | https://online.boneandjoint.org.uk/doi/10.1302/2633-1462.32.BJO-2021-0148.R1 |
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