Two-Stage Treatment of Chronic Periprosthetic Knee Infections With the Use of Gentamicin-Articulated Spacers: Success Rate and Predictors of Failure at the Minimum Seven-Year Follow-Up
Background: The purpose of this study was to assess the survivorship rates of 2-stage treatment with gentamicin-impregnated polymethylmethacrylate articulated knee spacer in patients with chronic periprosthetic joint infection and to identify risk factors associated with failure. Methods: We conduct...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-10-01
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| Series: | Arthroplasty Today |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352344123000821 |
| _version_ | 1797653957931171840 |
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| author | Joaquin Rodriguez, MD Leonel Perez Alamino, MD German Garabano, MD Juan Pablo Taleb, MD Hernan Del Sel, MD Cesar Pesciallo, MD |
| author_facet | Joaquin Rodriguez, MD Leonel Perez Alamino, MD German Garabano, MD Juan Pablo Taleb, MD Hernan Del Sel, MD Cesar Pesciallo, MD |
| author_sort | Joaquin Rodriguez, MD |
| collection | DOAJ |
| description | Background: The purpose of this study was to assess the survivorship rates of 2-stage treatment with gentamicin-impregnated polymethylmethacrylate articulated knee spacer in patients with chronic periprosthetic joint infection and to identify risk factors associated with failure. Methods: We conducted a retrospective study among 73 patients with chronic periprosthetic joint infection after primary total knee replacement with articulated polymethylmethacrylate gentamicin-impregnated spacers (Subiton, Medical Labs, Ind Argentina), performed in a single institution with a minimum follow-up of 7 years. Clinical and functional assessment was performed with Knee Society Score and Western and Ontario McMaster Universities Osteoarthritis Index. A univariate and multivariate analysis was performed to identify the variables that influenced the success and failure rates. Results: We included 73 patients. There were 53 (71.3%) monomicrobial, 11 (15%) polymicrobial, and 10 (13.7%) negative cultures infections. The success and failure rates were 90.5% (n = 66) and 9.5% (n = 7), respectively. Multivariate analysis identified that age (odds ratio = 1.77; P = .039), greater erythrocyte sedimentation rate values prior to the first stage (odds ratio = 1.04; P = .006), and polymicrobial infections (odds ratio = 7.32; P = .0003) were independent variables associated with failure. Conclusions: Two-stage revision with polymethylmethacrylate gentamicin-impregnated knee spacers is an effective strategy for the treatment of chronic periprosthetic joint infection after total knee arthroplasty. Age, higher erythrocyte sedimentation rate values prior first stage, and polymicrobial infections were independent risk factors for treatment failure. |
| first_indexed | 2024-03-11T16:52:23Z |
| format | Article |
| id | doaj.art-6aa16f3a290b4841be7a1bd0dcb8d18f |
| institution | Directory Open Access Journal |
| issn | 2352-3441 |
| language | English |
| last_indexed | 2024-03-11T16:52:23Z |
| publishDate | 2023-10-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Arthroplasty Today |
| spelling | doaj.art-6aa16f3a290b4841be7a1bd0dcb8d18f2023-10-21T04:22:42ZengElsevierArthroplasty Today2352-34412023-10-0123101177Two-Stage Treatment of Chronic Periprosthetic Knee Infections With the Use of Gentamicin-Articulated Spacers: Success Rate and Predictors of Failure at the Minimum Seven-Year Follow-UpJoaquin Rodriguez, MD0Leonel Perez Alamino, MD1German Garabano, MD2Juan Pablo Taleb, MD3Hernan Del Sel, MD4Cesar Pesciallo, MD5Department of Orthopaedic and Traumatology, British Hospital of Buenos Aires, Argentina, Ciudad Autónoma de Buenos AiresCorresponding author. Avda JM Moreno 477 – C1424, Ciudad Autónoma de Buenos Aires, Argentina. Tel.: +54 3814471444.; Department of Orthopaedic and Traumatology, British Hospital of Buenos Aires, Argentina, Ciudad Autónoma de Buenos AiresDepartment of Orthopaedic and Traumatology, British Hospital of Buenos Aires, Argentina, Ciudad Autónoma de Buenos AiresDepartment of Orthopaedic and Traumatology, British Hospital of Buenos Aires, Argentina, Ciudad Autónoma de Buenos AiresDepartment of Orthopaedic and Traumatology, British Hospital of Buenos Aires, Argentina, Ciudad Autónoma de Buenos AiresDepartment of Orthopaedic and Traumatology, British Hospital of Buenos Aires, Argentina, Ciudad Autónoma de Buenos AiresBackground: The purpose of this study was to assess the survivorship rates of 2-stage treatment with gentamicin-impregnated polymethylmethacrylate articulated knee spacer in patients with chronic periprosthetic joint infection and to identify risk factors associated with failure. Methods: We conducted a retrospective study among 73 patients with chronic periprosthetic joint infection after primary total knee replacement with articulated polymethylmethacrylate gentamicin-impregnated spacers (Subiton, Medical Labs, Ind Argentina), performed in a single institution with a minimum follow-up of 7 years. Clinical and functional assessment was performed with Knee Society Score and Western and Ontario McMaster Universities Osteoarthritis Index. A univariate and multivariate analysis was performed to identify the variables that influenced the success and failure rates. Results: We included 73 patients. There were 53 (71.3%) monomicrobial, 11 (15%) polymicrobial, and 10 (13.7%) negative cultures infections. The success and failure rates were 90.5% (n = 66) and 9.5% (n = 7), respectively. Multivariate analysis identified that age (odds ratio = 1.77; P = .039), greater erythrocyte sedimentation rate values prior to the first stage (odds ratio = 1.04; P = .006), and polymicrobial infections (odds ratio = 7.32; P = .0003) were independent variables associated with failure. Conclusions: Two-stage revision with polymethylmethacrylate gentamicin-impregnated knee spacers is an effective strategy for the treatment of chronic periprosthetic joint infection after total knee arthroplasty. Age, higher erythrocyte sedimentation rate values prior first stage, and polymicrobial infections were independent risk factors for treatment failure.http://www.sciencedirect.com/science/article/pii/S2352344123000821TKAPeriprosthetic joint infectionArticulating spacerMonomicrobial infectionPolymicrobial infection |
| spellingShingle | Joaquin Rodriguez, MD Leonel Perez Alamino, MD German Garabano, MD Juan Pablo Taleb, MD Hernan Del Sel, MD Cesar Pesciallo, MD Two-Stage Treatment of Chronic Periprosthetic Knee Infections With the Use of Gentamicin-Articulated Spacers: Success Rate and Predictors of Failure at the Minimum Seven-Year Follow-Up Arthroplasty Today TKA Periprosthetic joint infection Articulating spacer Monomicrobial infection Polymicrobial infection |
| title | Two-Stage Treatment of Chronic Periprosthetic Knee Infections With the Use of Gentamicin-Articulated Spacers: Success Rate and Predictors of Failure at the Minimum Seven-Year Follow-Up |
| title_full | Two-Stage Treatment of Chronic Periprosthetic Knee Infections With the Use of Gentamicin-Articulated Spacers: Success Rate and Predictors of Failure at the Minimum Seven-Year Follow-Up |
| title_fullStr | Two-Stage Treatment of Chronic Periprosthetic Knee Infections With the Use of Gentamicin-Articulated Spacers: Success Rate and Predictors of Failure at the Minimum Seven-Year Follow-Up |
| title_full_unstemmed | Two-Stage Treatment of Chronic Periprosthetic Knee Infections With the Use of Gentamicin-Articulated Spacers: Success Rate and Predictors of Failure at the Minimum Seven-Year Follow-Up |
| title_short | Two-Stage Treatment of Chronic Periprosthetic Knee Infections With the Use of Gentamicin-Articulated Spacers: Success Rate and Predictors of Failure at the Minimum Seven-Year Follow-Up |
| title_sort | two stage treatment of chronic periprosthetic knee infections with the use of gentamicin articulated spacers success rate and predictors of failure at the minimum seven year follow up |
| topic | TKA Periprosthetic joint infection Articulating spacer Monomicrobial infection Polymicrobial infection |
| url | http://www.sciencedirect.com/science/article/pii/S2352344123000821 |
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