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- Title
Repeat revision TKR for failed management of peri-prosthetic infection has long-term success but often require multiple operations: a case control study.
- Authors
Rajgor, Harshad; Dong, Huan; Nandra, Raj; Parry, Michael; Stevenson, Jonathan; Jeys, Lee
- Abstract
Background: Prosthetic joint infection (PJI) is associated with poor outcomes and catastrophic complications. The aim of this study was to present the outcomes of re-revision surgery for PJI of the knee following previous failed two-stage exchange arthroplasty. Materials and methods: A retrospective analysis was performed of 32 patients who underwent re-revision knee arthroplasty, having already undergone at least one previous two-stage exchange for PJI with a minimum follow-up of two-years for alive patients. Outcomes were compared to a matched control of two-stage revisions for PJI of a primary knee replacement also containing 32 patients. Outcomes investigated were eradication of infection, re-operation, mortality and limb-salvage rate. Results: Successful eradication of infection was achieved in 50% of patients following re-revision surgery, compared with 91% following two-stage exchange of primary knee replacement for PJI (p < 0.001). Fourteen (44%) patients required further re-operation compared with three (9%) patients in the primary group (p = 0.006). Amputation was performed in one case (3%) with thirteen patients (92%) who had infection controlled by debridement, antibiotics and implant retention (DAIR), further revision surgery or arthrodesis. Two patients died with infection (6%) and the long-term rate for infection control was 91%. The mean number of procedures following surgery for the re-revision group was 2.8 (0–9) compared with 0.13 (0–1) for the primary two-stage group (p < 0.001). Five-year patient survival was 90.6% (95% CI 77.1–100). The limb-salvage rate for the re-revision cohort was 97%. Conclusion: Outcomes for re-revision knee arthroplasty for PJI have higher re-operation and failure rates, but no worse mortality than in revisions of primary knee replacements. Failures can successfully be managed by further operation.
- Subjects
REOPERATION; TOTAL knee replacement; JOINT infections; ARTIFICIAL joints; KNEE surgery; INFECTION control
- Publication
Archives of Orthopaedic & Trauma Surgery, 2023, Vol 143, Issue 2, p987
- ISSN
0936-8051
- Publication type
Article
- DOI
10.1007/s00402-022-04594-z