Infection recurrence factors in one- and two-stage total knee prosthesis exchanges
Autor: | L. Lhotellier, C. Estellat, G. Pasquier, Alain Cazenave, Philippe Massin, Jean-Yves Jenny, O. Roche, Tristan Delory |
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Rok vydání: | 2015 |
Předmět: |
Male
Reoperation medicine.medical_specialty Prosthesis-Related Infections Knee Joint medicine.medical_treatment Logistic regression Prosthesis 03 medical and health sciences Sex Factors 0302 clinical medicine Recurrence Humans Medicine Orthopedics and Sports Medicine 030212 general & internal medicine Prosthesis-Related Infection Stage (cooking) Arthroplasty Replacement Knee Aged Retrospective Studies 030222 orthopedics business.industry Retrospective cohort study Odds ratio Middle Aged Anti-Bacterial Agents Surgery Radiological weapon Orthopedic surgery Female Knee Prosthesis business Follow-Up Studies |
Zdroj: | Knee Surgery, Sports Traumatology, Arthroscopy. 24:3131-3139 |
ISSN: | 1433-7347 0942-2056 |
DOI: | 10.1007/s00167-015-3884-1 |
Popis: | Revision of infected total knee replacements (TKR) is usually delayed for a period in which the joint space is filled with an antibiotic-loaded acrylic spacer. In contrast, one-stage re-implantation supposes immediate re-implantation. Formal comparisons between the two methods are scarce. A retrospective multi-centre study was conducted to investigate the effects of surgery type (one-stage vs. two-stage) on cure rates. It was hypothesised that this parameter would not influence the results. All infected TKR, treated consecutively between 2005 and 2010 by senior surgeons working in six referral hospitals, were included retrospectively. Two hundred and eighty-five patients, undergoing one-stage or two-stage TKR, with more than 2-year follow-up (clinical and radiological) were eligible for data collection and analysis. Of them, 108 underwent one-stage and 177 received two-stage TKR. Failure was defined as infection recurrence or persistence of the same or unknown pathogens. Factors linked with infection recurrence were analysed by uni- and multi-variate logistic regression with random intercept. Factors associated with infection recurrence were fistulae (odds ratio (OR) 3.4 [1.2–10.2], p = 0.03), infection by gram-negative bacteria (OR 3.3 [1.0–10.6], p = 0.05), and two-stage surgery with static spacers (OR 4.4 [1.1–17.9], p = 0.04). Gender and type of surgery interacted (p = 0.05). In men (133 patients), type of surgery showed no significant linkage with infection recurrence. In women (152 patients), two-stage surgery with static spacers was associated independently with infection recurrence (OR 5.9 [1.5–23.6], p = 0.01). Among patients without infection recurrence, International Knee Society scores were similar between those undergoing one-stage or two-stage exchanges. Two-stage procedures offered less benefit to female patients. It suggests that one-stage procedures are preferable, because they offer greater comfort without increasing the risk of recurrence. Routine one-stage procedures may be a reasonable option in the treatment of infected TKR. III. |
Databáze: | OpenAIRE |
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