Factors Influencing the Clinical Outcomes of Two-Stage Re-Implantation in Patients With Periprosthetic Joint Infection After Total Knee Arthroplasty.

Abstract

Introduction Infection is one of the most distressing complications of total knee arthroplasty (TKA), requiring a long treatment process and may negatively affect patient satisfaction. All surgeons aim to achieve infection-free survival, painless, functional, and stable knee after treatment of periprosthetic joint infection (PJI) with two-stage revision treatment. Many factors play a role in determining clinical outcomes. We aimed to evaluate the factors influencing the clinical outcomes of patients undergoing two-stage revision knee arthroplasty for PJI. Methods Forty-nine patients were retrospectively evaluated. Forty-four patients met the inclusion criteria. Spacer types, growth rates in culture, types and amount of antibiotics added to the cement, and intervals between stages were evaluated. Pre- and post-treatment infection parameters, changes in the range of motion (ROM), clinical and functional (C&F) Knee Society Score (KSS) results, and complications were also studied. Results After a mean follow-up of 48.8 ± 16.5 months, re-infection was detected in five out of 44 patients (10.4%). No significant difference was noted regarding C&F KSS when comparing time intervals between the two stages, whether they were shorter or longer than 10 weeks. However, better ROM results were obtained in patients with less than 10 weeks between stages. The relationship between spacer type, ROM, and C&F KSS was not found to be significant. Particularly, the addition of 4g of teicoplanin to the cement shortened the time between the two stages. Conclusion C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) levels can be considered safe parameters for diagnosis, reimplantation timing, and follow-up. The use of dynamic spacers or reimplantation performed within 10 weeks after the first stage is associated with better ROM outcomes. Additionally, the addition of teicoplanin to the cement shortened the duration of antibiotic therapy.