One- or two-stage reimplantation for infected total knee prosthesis?

Warran Wignadasan, Mazin Ibrahim, Fares S Haddad

Orthopaedics & traumatology, surgery & research : OTSR 2023 Feb

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A prosthetic joint infection (PJI) is possibly the most significant potential complication of total knee arthroplasty (TKA) and is associated with substantial morbidity and socioeconomic burden. It is a devastating complication for both the patient and the surgeon alike. A two-stage revision approach for infected TKA has been the standard for surgical management; however, there is growing interest in single-stage revision surgery due to fewer procedures, reduced inpatient hospital stay and reduced costs to healthcare systems. A one-stage exchange is indicated when there is no sign of systemic sepsis and in cases where a microorganism has been isolated. It involves removal of the old prosthesis, debridement of all infected tissue, a copious washout and re-draping, and finally, re-implantation of a new prosthesis. The two-stage approach involves the use of an antibiotic spacer before the second stage is carried out. The length of time between the stages is discussed. Patients with a PJI should be managed by a multidisciplinary team. We recommend these patients are managed in specialist arthroplasty centres by high volume revision arthroplasty specialists. Copyright © 2022 Elsevier Masson SAS. All rights reserved.

Citation

Warran Wignadasan, Mazin Ibrahim, Fares S Haddad. One- or two-stage reimplantation for infected total knee prosthesis? Orthopaedics & traumatology, surgery & research : OTSR. 2023 Feb;109(1S):103453