| Autor: |
Nagra, Navraj, Hamilton, Thomas, Ganatra, Sameer, Murray, David, Pandit, Hemant, Nagra, Navraj S, Hamilton, Thomas W, Murray, David W |
| Předmět: |
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| Zdroj: |
Knee Surgery, Sports Traumatology, Arthroscopy; Oct2016, Vol. 24 Issue 10, p3106-3114, 9p, 2 Diagrams, 3 Charts, 1 Graph |
| Abstrakt: |
Purpose: Infection complicating total knee arthroplasty (TKA) has serious implications. Traditionally the debate on whether one- or two-stage exchange arthroplasty is the optimum management of infected TKA has favoured two-stage procedures; however, a paradigm shift in opinion is emerging. This study aimed to establish whether current evidence supports one-stage revision for managing infected TKA based on reinfection rates and functional outcomes post-surgery.Methods: MEDLINE/PubMed and CENTRAL databases were reviewed for studies that compared one- and two-stage exchange arthroplasty TKA in more than ten patients with a minimum 2-year follow-up.Results: From an initial sample of 796, five cohort studies with a total of 231 patients (46 single-stage/185 two-stage; median patient age 66 years, range 61-71 years) met inclusion criteria. Overall, there were no significant differences in risk of reinfection following one- or two-stage exchange arthroplasty (OR -0.06, 95 % confidence interval -0.13, 0.01). Subgroup analysis revealed that in studies published since 2000, one-stage procedures have a significantly lower reinfection rate. One study investigated functional outcomes and reported that one-stage surgery was associated with superior functional outcomes. Scarcity of data, inconsistent study designs, surgical technique and antibiotic regime disparities limit recommendations that can be made.Conclusion: Recent studies suggest one-stage exchange arthroplasty may provide superior outcomes, including lower reinfection rates and superior function, in select patients. Clinically, for some patients, one-stage exchange arthroplasty may represent optimum treatment; however, patient selection criteria and key components of surgical and post-operative anti-microbial management remain to be defined.Level Of Evidence: III. [ABSTRACT FROM AUTHOR] |
| Databáze: |
Complementary Index |
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