Repeat Two-Stage Exchange Arthroplasty for Periprosthetic Knee Infection Is Dependent on Host Grade
| Autor: | Arlen D. Hanssen, Keith A. Fehring, Matthew P. Abdel, M Ollivier, Tad M. Mabry |
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| Přispěvatelé: | Institut des Sciences du Mouvement Etienne Jules Marey (ISM), Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS) |
| Rok vydání: | 2017 |
| Předmět: |
Reoperation
Prosthesis-Related Infections/drug therapy/*surgery medicine.medical_specialty Prosthesis-Related Infections medicine.medical_treatment Replacement Periprosthetic Arthroplasty Prosthesis Failure/adverse effects 03 medical and health sciences Exchange protocol 0302 clinical medicine Recurrence Risk Factors 80 and over medicine Humans Orthopedics and Sports Medicine Prosthesis-Related Infection Stage (cooking) Arthroplasty Replacement Knee Aged Retrospective Studies Aged 80 and over 030222 orthopedics business.industry Retrospective cohort study Level iv 030229 sport sciences General Medicine Middle Aged Knee/*adverse effects/methods Surgery Anti-Bacterial Agents Prosthesis Failure Anti-Bacterial Agents/therapeutic use Treatment Outcome Infection type [SDV.IB]Life Sciences [q-bio]/Bioengineering business |
| Zdroj: | The Journal of bone and joint surgery. American volume The Journal of bone and joint surgery. American volume, 2017, 99 (1), pp.19--24. ⟨10.2106/JBJS.16.00075⟩ |
| ISSN: | 1535-1386 |
| DOI: | 10.2106/JBJS.16.00075⟩ |
| Popis: | Place: United States; BACKGROUND: Two-stage exchange arthroplasty after a previous, failed 2-stage exchange procedure is fraught with difficulties, and there are no clear guidelines for treatment or prognosis given the heterogeneous group of patients in whom this procedure has been performed. The Musculoskeletal Infection Society (MSIS) staging system was developed in an attempt to stratify patients according to infection type, host status, and local soft-tissue status. The purpose of this study was to report the results of 2-stage exchange arthroplasty following a previous, failed 2-stage exchange protocol for periprosthetic knee infection as well as to identify risk factors for failure. METHODS: We retrospectively identified 45 patients who had undergone 2 or more 2-stage exchange arthroplasties for periprosthetic knee infection from 2000 to 2013. Patients were stratified according to the MSIS system, and risk factors for failure were analyzed. The minimum follow-up was 2 years (mean, 6 years; range, 24 to 132 months). RESULTS: At the time of follow-up, twenty-two (49%) of the patients had undergone another revision due to infection and 28 (62%) had undergone another revision for any reason. The infection recurred in 6 (75%) of 8 substantially immunocompromised hosts (MSIS type C) and in 3 (30%) of 10 uncompromised hosts (type A) following the second 2-stage exchange arthroplasty (p = 0.06). The infection recurred in 4 (80%) of 5 patients with compromise of the extremity (MSIS type 3) and 3 (33%) of 9 patients with an uncompromised extremity (type 1) (p = 0.27). Both extremely compromised hosts with an extremely compromised extremity (type C3) had recurrence of the infection whereas 3 (30%) of the 10 uncompromised patients with no or less compromise of the extremity (type A1 or A2) did. Five patients in the failure group underwent a third 2-stage exchange arthroplasty following reinfection, and 3 of them were infection-free at the time of the latest follow-up. CONCLUSIONS: Uncompromised hosts (MSIS type A) with an acceptable wound (MSIS type 1 or 2) had a 70% rate of success (7 of 10) after a repeat 2-stage exchange arthroplasty, whereas type-B2 hosts had a 50% success rate (10 of 20). The repeat 2-stage exchange procedure failed in both type-C3 hosts; thus, alternative salvage procedures should be considered for such patients. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. |
| Databáze: | OpenAIRE |
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