Experiences during Switching from Two-Stage to One-Stage Revision Arthroplasty for Chronic Total Knee Arthroplasty Infection.

Guillem Navarro,Rosa Bori,Guillem Bori,Luis Lozano,Sergi Sastre,Jordi Bosch

doi:10.3390/antibiotics10121436

Abstract

The objective of this study was to evaluate our preliminary results after changing our surgical strategy from 2-stage revision arthroplasty to 1-stage revision arthroplasty for patients with chronic knee periprosthetic joint infection. We conducted a prospective study of knee arthroplasty patients that had been diagnosed with chronic infection and treated using a 1-stage revision regardless of the traditional criteria applied for indication thereof. We evaluated two main variables: infection control and economic costs. The definitive diagnosis of infection of the revision was determined by using the criteria proposed by the Musculoskeletal Infection Society. The costs were calculated as average costs in USD, as described by Srivastava (2019), for 1-stage or 2-stage revisions. Eighteen patients were included in the study, and infection was controlled in 17 patients. The total economic savings for our hospital from these 18 patients amounted to USD 291,152. This clinical success has led to major changes in how our hospital approaches the treatment of chronically infected knee replacements, in addition to substantial economic advantages for the hospital.

Highlights

The treatment of chronic periprosthetic joint infection (PJI) is a source of considerable unease and confusion for arthroplasty surgeons
2-stage revision has been advocated for the treatment of chronic knee PJI [2,3]
Thirty-nine patients were preoperatively diagnosed with chronic knee PJI from

Summary

Introduction

The treatment of chronic periprosthetic joint infection (PJI) is a source of considerable unease and confusion for arthroplasty surgeons. PJI remains a serious complication after total knee arthroplasty (TKA) and is one of the leading causes of TKA revision surgery. Two approaches are generally used in the setting of chronic PJI of the TKA: 1-stage and 2-stage revision [1,2]. 2-stage revision has been advocated for the treatment of chronic knee PJI [2,3]. This strategy requires, in the first stage, removal of infected components, an interim period with antibiotic treatment, and limited mobilization followed by a second stage with reimplantation of revision components. A 1-stage revision is an alternative to a

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