Study: Single-stage arthroplasty exchange may be viable alternative for THA, TKA
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Key takeaways:
- Results showed single-stage exchange arthroplasty may be a viable alternative to two stage in patients undergoing THA or TKA.
- Researchers said further research is necessary to prove statistical significance.
Results presented at the Musculoskeletal Infection Society Annual Meeting showed single-stage arthroplasty exchange may be an alternative to two-stage exchange in patients without prior infection surgery and bone or soft tissue compromise.
“Based on the results of our study, we found that at our institution single-stage [exchange] had a lower rate of re-revision, higher rate of 1-year [periprosthetic joint infection] PJI free and a higher rate of [Musculoskeletal Infection Society] MSIS surgical success for the overall cohort,” Ryan M. Sutton, MD, said in his presentation. “But when you broke things down into subgroup analysis, there were minimal differences noted and again, it should be pointed out that the single-stage group had a higher percentage of patients on chronic antibiotic suppression.”
In a retrospective review of data for 126 patients with documented PJI who underwent revision TKA or THA from 2017 to 2021, Sutton and colleagues compared surgical success and re-revision rates between single-stage and two-stage exchange arthroplasty for chronic PJI.
“We defined surgical success as set forth by the MSIS a few years ago, with success being defined as tier one and tier two disease not requiring further operation afterward,” Sutton said.
He continued, “We manually collected the data from all of our preoperative and postoperative inpatient records, as well as outpatient records and lab results, and we evaluated notes from orthopedic surgeons, plastic surgeons and infectious disease physicians.”
Researchers found a higher rate of re-revision for patients in the two-stage group. In addition, Sutton said there was a higher rate of PJI-free patients at follow-up in the single-stage group.
Sutton said there was a higher rate of surgical success in the single-stage group, with a 90% rate of success vs. a 74% rate of success for patients in the two-stage group. However, after accounting for subgroup analysis, Sutton said there were minimal statistically significant differences between the two groups.
“With strict selection criteria, no prior PJI surgery, [and] no bone or soft tissue compromise, single stage appears to be a viable alternative to the conventional two stage in select patients,” Sutton said. “However, there's still a pressing need for prospective randomized studies with long-term follow-up to further evaluate this.”
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Sutton RM, et al. Paper 1070. Presented at: Musculoskeletal Infection Society Annual Meeting; Aug. 4-5, 2023; Salt Lake City (hybrid meeting).
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