Reinfection and Re-revision Rates of Periprosthetic Knee Infection Under Four Different Surgical Strategies

Fujian Medical University (FJMU)

Status: Completed

Conditions: Periprosthetic Joint Infection (PJI); Reinfection; Aseptic Loosening; Revision; Total Knee Arthroplasty

Study type: Observational

Funder types: Other

Identifiers

NCT07232771

MTCA,ECFAH of FMU[2019]296

Details and patient eligibility

About

A single-center retrospective cohort study was conducted in the Department of Orthopedics, the First Affiliated Hospital of Fujian Medical University. This study reviewed 145 patients who underwent debridement, antibiotics, and implant retention (DAIR), 1-stage revision, 1.5-stage revision, and 2-stage revision surgeries for total knee arthroplasty periprosthetic joint infection (TKA-PJI) at this institution between 2012 and 2022. The differences in postoperative reinfection rate, microbial composition of reinfection, short-term and long-term aseptic prosthesis survival rate, prosthesis loosening and revision rate due to any cause, and long-term loosening-free survival rate among the four revision surgical approaches for TKA-PJI were evaluated, so as to provide reference value for clinical decision-making.

Full description

A single-center retrospective cohort study was conducted in the Department of Orthopedics, the First Affiliated Hospital of Fujian Medical University. This study reviewed 145 patients who underwent debridement, antibiotics, and implant retention (DAIR), 1-stage revision, 1.5-stage revision, and 2-stage revision surgeries for total knee arthroplasty periprosthetic joint infection (TKA-PJI) at this institution between 2012 and 2022. In this study, we aimed to evaluate: (1) the postoperative reinfection rates following four surgical strategies for TKA-PJI; (2) the microbial profile of recurrent infections; (3) short- and long-term infection-free implant survival rates across the four surgical approaches; (4) re-revision rates due to aseptic loosening and long-term aseptic loosening-free implant survival rates; and (5) the reinfection rate in patients with positive cultures at the time of reimplantation. In order to provide reference value for clinical decision-making.

Enrollment: 200 patients

Sex: All

Volunteers: No Healthy Volunteers

Inclusion and exclusion criteria

Inclusion Criteria

1. Patients who met the diagnostic criteria for TKA-PJI;
2. Patients who underwent one of the following surgical interventions: DAIR, one-stage revision, 1.5-stage revision, or two-stage revision;
3. Patients with complete medical records available;
4. Patients who provided informed consent to participate in the study.

Exclusion Criteria:

1. Incomplete medical records;
2. Poor follow-up compliance, including inability to complete scheduled follow-up visits or refusal to participate in follow-up;
3. Follow-up duration less than 2 years.

Trial design

200 participants in 4 patient groups

DAIR group

Description:

DAIR revision involves washout, thorough debridement, antibiotics, and all components of implant retention, but polyethylene exchange

1-stage revision group

Description:

One-stage revision involves open debridement of the infected knee, followed by immediate revision by removal and or reimplantation of all components

1.5-stage revision group

Description:

The 1.5-stage revision involves the use of a functional, articulating antibiotic-loaded knee spacer intended for long-term retention-either indefinitely or until loosening necessitates definitive TKA revision. We standardize the terminology for this procedure as "1.5-stage revision", as it represents an intermediate strategy between one-stage and two-stage revision for the treatment of PJI following TKA

2-stage revision group

Description:

Two-stage revision, with removal of implants, placement of an antibiotic spacer, and parenteral antibiotic treatment followed by TKA reimplantation has been proposed as the "gold standard" for chronic PJI treatment