Patient reported outcome measures after revision of the infected TKR: comparison of single versus two-stage revision

Abstract

Two-stage revision is the 'gold standard' treatment for infected total knee replacement. Single-stage revision has been successful in the hip and, in carefully chosen knee revisions, may offer the advantage of a single surgical insult with improved functional outcome. Patient Reported Outcome Measures (PROMs) for 33 single- and 89 two-stage revisions performed for infection were analysed in combination with data from the National Joint Registry for England and Wales. Outcomes including the Oxford Knee Score (OKS), Euroqol-5D (EQ5D) and patient satisfaction were examined with the aim of investigating the following questions: does single- or two-stage revision for infection result in (1) better knee function; (2) better overall perception of health status; (3) better patient perceived success and satisfaction? No statistical difference was found between the groups for any reported outcome measure. Mean OKS following surgery was 24.9 (95 %CI, 20.5-29.4) for single- and 22.8 (95 %CI, 20.2-25.4) for two-stage (n.s.). Mean EQ5D index following surgery was 0.495 (95 %CI, 0.357-0.632) for single and 0.473 (95 %CI, 0.397-0.548) for two-stage (n.s.). Patients reporting Excellent/Very good/Good satisfaction were similar between the groups (single = 61 % vs. two stage = 57 %, (n.s.)). In total, 66 % single- and 60 % two-stage operations were rated 'successful' (n.s.). This study found no demonstrable benefit of single-stage compared to two-stage revision for the infected total knee replacement using a variety of PROMs. Thus, we recommend that decision making must be based on other factors such as re-infection rate.