Orthopaedic Knowledge Update®: Musculoskeletal Infection 2 Print + Ebook (AAOS - American Academy of Orthopaedic Surgeons)

Chapter 16: Surgical Treatment of Hip and Knee Prosthetic Joint Infections

61. Gehrke T, Zahar A, Kendoff D: One-stage exchange: It all began here. Bone Joint J 2013;95-B(11 suppl A):77-83. 62. Parvizi J, Gehrke T, Chen A: Proceedings of the interna tional consensus on periprosthetic joint infection. Bone Joint J 2013;95-B(11):1450-1452. 63. Thakrar R, Horriat S, Kayani B, Haddad F: Indications for a single-stage exchange arthroplasty for chronic prosthetic joint infection: A systematic review. Bone Joint J 2019; 101-B(1 suppl A):19-24. This systematic review included 962 patients to determine factors that would predict treatment failure in a single-stage revision for PJI. It was concluded that the indications are the absence of severe immunocompromise, significant soft-tissue or bony compromise, and concurrent sepsis. A two-stage revi sion should be used in patients with multidrug-resistant or atypical organisms causing their PJI. Level of evidence: III. 64. Dombrowski M, Wilson A, Wawrose R, O’Malley M, Urish K, Klatt B: A low percentage of patients satisfy typ ical indications for single-stage exchange arthroplasty for chronic periprosthetic joint infection. Clin Orthop Relat Res 2020;478(8):1780-1786. This study analyzed the patient population and determined that only 19% (20 of 108 patients) would actually meet the ICM criteria for a single-stage exchange. Level of evidence: III. 65. Ji B, Wahafu T, Li G, et al: Single-stage treatment of chron ically infected total hip arthroplasty with cementless recon struction: Results in 126 patients with broad inclusion criteria. Bone Joint J 2019;101-B(4):396-402. This study of 126 patients with broad inclusion criteria who underwent a single-stage revision reported that 99 of 111 patients (89%) were free of infection at mean follow-up of 58 months. Level of evidence: IV. 66. Zahar A, Klaber I, Gerken AM, et al: Ten-year results following one-stage septic hip exchange in the manage ment of periprosthetic joint infection. J Arthroplasty 2019;34(6):1221-1226. This group’s specific protocol for single-stage hip exchange had excellent 10-year infection-free survival rate of 94% and a surgery-free survival rate of 75.9% in patients who were followed up. Level of evidence: IV. 67. Srivastava K, Bozic KJ, Silverton C, Nelson AJ, Makhni EC, Davis JJ: Reconsidering strategies for managing chronic peri prosthetic joint infection in total knee arthroplasty: Using decision analytics to find the optimal strategy between one stage and two-stage total knee revision. J Bone Joint Surg Am 2019;101(1):14-24. A Monte Carlo simulation favored single-stage revision for quality-adjusted life-years and cost outcomes at 85% and 69%, respectively. Level of evidence: IV.

68. Bori G, Navarro G, Morata L, Fernández-Valencia JA, Soriano A, Gallart X: Preliminary results after changing from two-stage to one-stage revision arthroplasty proto col using cementless arthroplasty for chronic infected hip replacements. J Arthroplasty 2018;33(2):527-532. Prospective cohort study of 19 patients that underwent single-stage exchange for chronic PJI. The authors report successful treatment in 18 patients with significant cost savings as compared to two stage treatment. Level of evi dence: IV. 69. Fehring KA, Curtin BM, Springer BD, Fehring TK: One-stage periprosthetic joint infection reimbursement—Is it worth the effort? J Arthroplasty 2019;34(9):2072-2074. Cost analysis of reimbursement divided by the intraoperative time demonstrated approximately one-third of the hourly rate for a physician performing a single-stage procedure. Level of evidence: III. 70. Goldman AH, Clark NJ, Taunton MJ, Lewallen DG, Berry DJ, Abdel MP: Definitive resection arthroplasty of the knee: A surprisingly viable treatment to manage intractable infection in selected patients. J Arthroplasty 2020;35(3):855-858. This study demonstrates very poor outcomes for a rare proce dure of resection arthroplasty of the knee. Level of evidence: IV. 71. Trouillez T, Faure PA, Martinot P, et al: Above–the–knee amputation versus knee arthrodesis for revision of infected total knee arthroplasty: Recurrent infection rates and func tional outcomes of 43 patients at a mean follow-up of 6.7 years. Orthop Traumatol Surg Res 2021;107(4):102914. This study reviewed 20 patients who underwent a trans femoral amputation and 23 patients who underwent knee arthrodesis. The patients who underwent transfemoral ampu tation had less pain and improved quality of life. Level of evidence: IV. 72. Hungerer S, Kiechle M, von Rüden C, Militz M, Beitzel K, Morgenstern M: Knee arthrodesis versus above-the-knee amputation after septic failure of revision total knee arthro plasty: Comparison of functional outcome and complication rates. BMC Musculoskelet Disord 2017;18:443-447. 73. Vincenten CM, Den Oudsten BL, Bos PK, Bolder SB, Gosens T: Quality of life and health status after Girdlestone resection arthroplasty in patients with an infected total hip prosthesis. J Bone Jt Infect 2019;4(1):10-15.

Section 4: Prosthetic Joint Infections

Sixty-three patients who underwent a Girdlestone resection arthroplasty at a median follow-up of 48 months demon strated poor outcomes. Quality-of-life measures were worse than in those with amputations or those patients with myo cardial infarctions. Level of evidence: IV. Copyright © Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited. 2023

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Orthopaedic Knowledge Update ® : Musculoskeletal Infection 2