We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
One-stage versus two-stage exchange arthroplasty for infected total knee arthroplasty: a systematic review.
- Authors
Nagra, Navraj; Hamilton, Thomas; Ganatra, Sameer; Murray, David; Pandit, Hemant; Nagra, Navraj S; Hamilton, Thomas W; Murray, David W
- Abstract
<bold>Purpose: </bold>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.<bold>Methods: </bold>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.<bold>Results: </bold>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.<bold>Conclusion: </bold>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.<bold>Level Of Evidence: </bold>III.
- Subjects
TOTAL knee replacement; JOINT infections; PLASTIC surgery complications; HEALTH outcome assessment; ANTI-infective agents; META-analysis; ANTIBIOTICS; ARTIFICIAL joints; INFECTION; COMPLICATIONS of prosthesis; REOPERATION; SYSTEMATIC reviews; PATIENT selection
- Publication
Knee Surgery, Sports Traumatology, Arthroscopy, 2016, Vol 24, Issue 10, p3106
- ISSN
0942-2056
- Publication type
journal article
- DOI
10.1007/s00167-015-3780-8