A Modified Technique for Two-Stage Revision in Knee PJI Treatment
Knee PJIs represent one of the most important complications after joint replacement surgery. If the prerequisites for implant retention do not subsist, the surgical treatment of these conditions is performed using one-stage and two-stage revision techniques. In this study, an implemented two-stage r...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-11-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/12/23/7323 |
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| author | Raffaele Iorio Ferdinando Iannotti Leonardo Previ Edoardo Viglietta Yuri Gugliotta Federico Corsetti Simone Fenucci Angelo De Carli Pier Francesco Indelli Andrea Redler |
| author_facet | Raffaele Iorio Ferdinando Iannotti Leonardo Previ Edoardo Viglietta Yuri Gugliotta Federico Corsetti Simone Fenucci Angelo De Carli Pier Francesco Indelli Andrea Redler |
| author_sort | Raffaele Iorio |
| collection | DOAJ |
| description | Knee PJIs represent one of the most important complications after joint replacement surgery. If the prerequisites for implant retention do not subsist, the surgical treatment of these conditions is performed using one-stage and two-stage revision techniques. In this study, an implemented two-stage revision technique was performed, adopting antibiotic calcium sulfate beads and tumor-like debridement guided by methylene blue, such as described for the DAPRI technique. The aim of the present study is to compare the implemented two-stage revision technique with the standard technique in order to assess its effectiveness. Methods. Twenty patients affected by knee PJIs were prospectively enrolled in the study and underwent an implemented two-stage revision technique (Group A). Data collected and clinical results were compared with a matched control group treated with a standard two-stage technique (Group B). For each patient, the time of the reimplantation and length of antibiotic systemic therapy were recorded. Each patient underwent routine laboratory tests, including inflammatory markers. Results. In Group A and in Group B, inflammatory markers normalized at 6.5 ± 1.1. weeks and 11.1 ± 2.3 weeks, respectively (<i>p</i> < 0.05). Also, the difference in length of antibiotic therapy and time to reimplantation were significantly shorter in Group A (<i>p</i> < 0.05). No recurrence of infection was found in Group A at the last follow-up. Discussion. The implemented two-stage revision technique demonstrated a faster normalization of inflammatory markers, as well as a decrease in reimplantation time and duration of antibiotic therapy, compared to the traditional technique. The use of calcium sulfate antibiotic beads and tumor-like debridement seems to improve the results and reduce the time of healing. Conclusion. The implemented two-stage revision technique seems to improve the results and reduce the time of healing. This leads to a more rapid and less stressful course for the patient, as well as a reduction in health care costs. |
| first_indexed | 2024-03-09T01:48:57Z |
| format | Article |
| id | doaj.art-7a12a6d7e86d4c9da02421a99deed1dc |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-09T01:48:57Z |
| publishDate | 2023-11-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-7a12a6d7e86d4c9da02421a99deed1dc2023-12-08T15:19:24ZengMDPI AGJournal of Clinical Medicine2077-03832023-11-011223732310.3390/jcm12237323A Modified Technique for Two-Stage Revision in Knee PJI TreatmentRaffaele Iorio0Ferdinando Iannotti1Leonardo Previ2Edoardo Viglietta3Yuri Gugliotta4Federico Corsetti5Simone Fenucci6Angelo De Carli7Pier Francesco Indelli8Andrea Redler9Orthopaedic Unit, S. Andrea Hospital, University of Rome, “La Sapienza” Via Di Grottarossa 1035, 00189 Rome, ItalyDivision Orthopaedic Surgery, Ospedale San Paolo, 00053 Civitavecchia, ItalyOrthopaedic Unit, S. Andrea Hospital, University of Rome, “La Sapienza” Via Di Grottarossa 1035, 00189 Rome, ItalyOrthopaedic Unit, S. Andrea Hospital, University of Rome, “La Sapienza” Via Di Grottarossa 1035, 00189 Rome, ItalyOrthopaedic Unit, S. Andrea Hospital, University of Rome, “La Sapienza” Via Di Grottarossa 1035, 00189 Rome, ItalyOrthopaedic Unit, S. Andrea Hospital, University of Rome, “La Sapienza” Via Di Grottarossa 1035, 00189 Rome, ItalyOrthopaedic Unit, S. Andrea Hospital, University of Rome, “La Sapienza” Via Di Grottarossa 1035, 00189 Rome, ItalyOrthopaedic Unit, S. Andrea Hospital, University of Rome, “La Sapienza” Via Di Grottarossa 1035, 00189 Rome, ItalyDepartment of Orthopedic Surgery, Stanford University of School of Medicine, Stanford, CA 94063, USAOrthopaedic Unit, S. Andrea Hospital, University of Rome, “La Sapienza” Via Di Grottarossa 1035, 00189 Rome, ItalyKnee PJIs represent one of the most important complications after joint replacement surgery. If the prerequisites for implant retention do not subsist, the surgical treatment of these conditions is performed using one-stage and two-stage revision techniques. In this study, an implemented two-stage revision technique was performed, adopting antibiotic calcium sulfate beads and tumor-like debridement guided by methylene blue, such as described for the DAPRI technique. The aim of the present study is to compare the implemented two-stage revision technique with the standard technique in order to assess its effectiveness. Methods. Twenty patients affected by knee PJIs were prospectively enrolled in the study and underwent an implemented two-stage revision technique (Group A). Data collected and clinical results were compared with a matched control group treated with a standard two-stage technique (Group B). For each patient, the time of the reimplantation and length of antibiotic systemic therapy were recorded. Each patient underwent routine laboratory tests, including inflammatory markers. Results. In Group A and in Group B, inflammatory markers normalized at 6.5 ± 1.1. weeks and 11.1 ± 2.3 weeks, respectively (<i>p</i> < 0.05). Also, the difference in length of antibiotic therapy and time to reimplantation were significantly shorter in Group A (<i>p</i> < 0.05). No recurrence of infection was found in Group A at the last follow-up. Discussion. The implemented two-stage revision technique demonstrated a faster normalization of inflammatory markers, as well as a decrease in reimplantation time and duration of antibiotic therapy, compared to the traditional technique. The use of calcium sulfate antibiotic beads and tumor-like debridement seems to improve the results and reduce the time of healing. Conclusion. The implemented two-stage revision technique seems to improve the results and reduce the time of healing. This leads to a more rapid and less stressful course for the patient, as well as a reduction in health care costs.https://www.mdpi.com/2077-0383/12/23/7323periprosthetic joint infectiontwo-stage revisionrevision total knee arthroplastyDAPRI technique |
| spellingShingle | Raffaele Iorio Ferdinando Iannotti Leonardo Previ Edoardo Viglietta Yuri Gugliotta Federico Corsetti Simone Fenucci Angelo De Carli Pier Francesco Indelli Andrea Redler A Modified Technique for Two-Stage Revision in Knee PJI Treatment Journal of Clinical Medicine periprosthetic joint infection two-stage revision revision total knee arthroplasty DAPRI technique |
| title | A Modified Technique for Two-Stage Revision in Knee PJI Treatment |
| title_full | A Modified Technique for Two-Stage Revision in Knee PJI Treatment |
| title_fullStr | A Modified Technique for Two-Stage Revision in Knee PJI Treatment |
| title_full_unstemmed | A Modified Technique for Two-Stage Revision in Knee PJI Treatment |
| title_short | A Modified Technique for Two-Stage Revision in Knee PJI Treatment |
| title_sort | modified technique for two stage revision in knee pji treatment |
| topic | periprosthetic joint infection two-stage revision revision total knee arthroplasty DAPRI technique |
| url | https://www.mdpi.com/2077-0383/12/23/7323 |
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