Middle term result of two-stage total knee arthroplasty for prosthetic knee joint infection

Abstract

Introduction: The treatment of periprosthetic joint infection (PJI) after total knee arthroplasty (TKA) is a challengeable task. Two-stage exchange arthroplasty is a commonly used treatment for chronic PJI. Purpose: The aim of this study was to investigate the successful rate and possible failure risk factors in patients undergoing a planned two-stage exchange arthroplasty for treatment of knee PJI. Methods: From March 2004 to February 2015, we retrospectively reviewed 35 patients have more than 36 months clinical follow-up with periprosthetic knee joint infections. The clinical outcomes were recorded to define the successful or fail treatment for the periprosthetic knee joint infections. Multiple factors such as obesity, comorbidities, diabetes, were recorded and analyzed to evaluate the risk factors of poor outcome. Results: Five patients were unable to receive second stage surgery with cement spacer retained due to variable reasons. Three patients ended with amputation due to uncontrolled infectious process. Overall 27 patients received two-stage exchange arthroplasty to treat knee PJI were analyzed in this study. However, two patients were loss follow-up during the period between 1st and 2nd time surgery. Two patients were treated with static cement spacer due to poor soft tissue condition. These 4 patients were excluded and overall 23 patients were included and analyzed. Overall success rate is 78.26%. 4 patients with recurrent infection were treated with additional surgical debridement. One patient with recurrent infection was treated with the second time two-stage arthroplasty. All of these patients were successful treated without further recurrent infection. Conclusion: We found that failure rate is increasing when considerate the failure between first stage and second stage surgery. In addition, patients without more than 36 months follow-up may have infection free due to honeymoon period but still in risk of reinfection.