Single-Stage Revision Surgery in Infected Total Knee Arthroplasty: A PRISMA Systematic Review.

Khaled Yaghmour,Wasim Khan,Emanuele Chisari

doi:10.3390/jcm8020174

Abstract

Periprosthetic joint infection in total knee arthroplasty is a significant complication that is a common reason for revision surgery. The current standard of care is two-stage revision surgery. There is however increasing evidence to support the use of single-stage revision surgery. We conducted a PRISMA systematic review of the current evidence on the use of single-stage revision for infected total knee arthroplasty. Four databases (PubMed, Embase, Science Direct, and Cochrane Library) were systematically screened for eligible studies. The risk bias of each study was identified using ROBINS-I tool, and the quality of evidence was assessed using the GRADE criteria. Sixteen articles were retained after applying the inclusion and exclusion criteria that evaluated 3645 knee single-stage revision surgeries. Our review reveals satisfactory outcomes for single-stage revision in the management of infected total knee arthroplasty. The reinfection rates in the studies included in our review varied however the majority reported low reinfection rates and good functional outcomes. Although strict patient selection criteria have yielded successful results, good results were also reported when these criteria were not applied. The greater use of risk factors in identifying patients likely to have a successful outcome needs to be balanced with the practical benefits of performing a single stage procedure in higher risk patients. Future large clinical randomized control trials are required to confirm our results.

Highlights

According to the United Kingdom (UK) National Joint Registry (NJR), there have been 1,087,611 total knee arthroplasty (TKA) procedures reported from the 1st of April 2003 till the 31st of December 2017 [1]
In the United States (US) alone it is approximated that the need for TKA will substantially increase by 673% equating to 3.48 million procedures by 2030 [2]
Several factors are associated with an increased risk of developing Periprosthetic joint infection (PJI), these include a surgical site infection not involving the joint prosthesis, a National Nosocomial Infections Surveillance (NNIS) System surgical patient risk index score of 1 or 2 and existing malignancy [6]

Summary

Introduction

According to the United Kingdom (UK) National Joint Registry (NJR), there have been 1,087,611 total knee arthroplasty (TKA) procedures reported from the 1st of April 2003 till the 31st of December 2017 [1]. In the United States (US) alone it is approximated that the need for TKA will substantially increase by 673% equating to 3.48 million procedures by 2030 [2]. In a recent study [5], it was concluded that PJI account for 26.8% of revision surgeries. Several factors are associated with an increased risk of developing PJI, these include a surgical site infection not involving the joint prosthesis, a National Nosocomial Infections Surveillance (NNIS) System surgical patient risk index score of 1 or 2 and existing malignancy [6]

Objectives

Methods

Conclusion