One-stage exchange strategy with extensive debridement for chronic periprosthetic joint infection following total knee arthroplasty is associated with a low relapse rate in non-selected patients: a prospective single-center analysis - 25/01/25
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Abstract |
Purpose |
This prospective clinical cohort was undertaken to determine the long-term risks of reinfection and all-cause aseptic failure after 1-stage exchange total knee arthroplasties (TKA) in a large series of consecutive patients with periprosthetic joint infection (PJI) following TKA.
Hypothesis |
One-stage exchange for chronic PJI is an effective strategy, even in a non-selected population.
Patients and methods |
Non-selected patients (152 with 154 PJI) undergoing 1-stage-exchange TKA for PJI (January 2003–August 2015) were prospectively included and monitored for ≥2 years. PJI following TKA satisfying Musculoskeletal Infection Society diagnostic criteria were documented by microbiological culture results of preoperative joint aspirates and/or intraoperative samples. The cumulative incidences of total reinfections (i.e., relapses or new infections) and aseptic revisions were assessed. The mean follow-up (FU) duration was 7.5 years post-reimplantation.
Results |
At the last follow-up, 35 knees had developed reinfections: 7 relapses and 28 new infections, with respective 14-year cumulative incidences of 4.8% and 20.6%. The 2-, 5- and 14-year cumulative total reinfection incidences were 12.3%, 21.3% and 24.3%, respectively. Respective 2-, 5-, 10- and 14-year aseptic component-revision incidences were 0.7%, 3.2%, 5.4% and 13.4%. Multivariate analysis retained male sex (HR 3.27, p < 0.01) and preoperative atrial fibrillation (HR 3.03; p = 0.01) as being significantly associated with greater risk of reinfection.
Conclusions |
One-stage-exchange TKA with aggressive debridement for chronic PJI is apparently a valid strategy, even for non-selected patients. It was associated with a low relapse rate, prevented morbidity and avoided economic social costs of 2-stage exchange. New infections with a different microorganism were observed more frequently and occurred even after years of FU.
Level of evidence |
II; Therapeutic.
Le texte complet de cet article est disponible en PDF.Keywords : One-stage exchange, Periprosthetic infection, Chronic, Total knee arthroplasty
Plan
Vol 111 - N° 1
Article 104019- février 2025 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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