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Surgeons may expect similar outcomes for one-, two-stage exchange for knee PJI
The one-stage exchange was associated with a lower overall cost and shorter hospitalization period.
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A two-stage component exchange for periprosthetic joint infection is the gold standard treatment, but a one-stage component exchange procedure following total knee arthroplasty can yield similar results and may require a single operation, according to a presenter.
Thorsten Gehrke, MD, said a one-stage exchange to treat periprosthetic joint infection (PJI) following total knee arthroplasty (TKA) has a high success rate and it is used more often than two-stage exchanges at the ENDO-Klinik where Gehrke works.
“If you are going deeper into the literature and you are looking at the reviews, then you can see at the end that there is no difference between a one-stage and two-stage exchange. Here is a nice paper from BMC Medicine where they reviewed more than 4,000 unselected patients and they found out there is no difference between one- and two-stage [exchange procedures],” Gehrke said at the Current Concepts in Joint Replacement Spring Meeting.
Similar outcomes reported
A one-stage exchange has failure rates similar to a two-stage exchange of 9% to 20% at 8 years to 10 years follow-up. For it to be successful, a treatment plan should be created by an experienced microbiologist prior to the surgery, Gehrke said.
One of the main principles for the success of one-stage TKA exchanges is aggressive and complete debridement of all infected soft tissue and bone material, he noted.
“You have to work a little bit like a tumor surgeon; be radical, especially in the posterior part of the knee which is quite scary sometimes, but it must be done. This debridement should exclude the bone, of course, but after you have taken the last sample, we start with the antibiotic therapy systematically. We change the drapes, change the instruments, and then mix antibiotics into the bone cement due to the susceptibility of the germs,” Gehrke said.
Postoperative antibiotics are administered for 10 days to 14 days and an aggressive mobilization program that begins within the first 8 days should be considered, he said.
Lower cost, high satisfaction noted
Gehrke and colleagues analyzed 70 patients who underwent a one-stage TKA component exchange for PJI. Success in the study was defined as infection control with no recurrence, no further surgery and no signs of local or systemic infection.
At 10 years follow-up, six patients experienced aseptic failures and one patient experienced a periprosthetic fracture. At final follow-up, the success rate of the procedure was 91.5%, Gehrke said.
A one-stage exchange has a lower overall cost, relatively high patient satisfaction and a reduced need for systemic antibiotics compared with a two-stage exchange. However, an experienced microbiologist should create a well-defined preoperative plan for the procedure to be successful, Gehrke said. – by Robert Linnehan
- References:
- Beswick AD, et al. BMC Med. 2012. doi:10.1186/1741-7015-10-18.
- Gehrke T. Paper #59. Presented at: Current Concepts in Joint Replacement Spring Meeting; May 17-20, 2015; Las Vegas.
- For more information:
- Thorsten Gehrke, MD, can be reached at the ENDO-Klinik, Holstenstraße 2, 22767 Hamburg, Germany; email: thorsten.gehrke@helios-kliniken.de.
Disclosure: Gehrke reports he receives consulting fees from Zimmer Biomet, CD-Diagnostics and Waldemar Link GmbH & Co.