Outcome of Single-stage Versus Two-stage Exchange for Revision Knee Arthroplasty for Chronic Periprosthetic Infection

Overview

Journal EFORT Open Rev

Specialty Orthopedics

Date 2019 Sep 21

PMID 31537999

Citations 71

Authors

Corentin Pangaud

Matthieu Ollivier

Jean-Noel Argenson

Affiliations

Soon will be listed here.

Abstract

The gold standard for treating chronic periprosthetic joint infection is still considered to be double-stage exchange revision. The purpose of this review is to analyse the difference in terms of eradication rates and functional outcome after single- and double-stage prosthetic exchange for chronic periprosthetic joint infection around the knee.We reviewed full text articles written in English from 1992 to 2018 reporting the success rates and functional outcomes of either single-stage exchange or double-stage exchange for knee arthroplasty revision performed for chronic infection. In the case of double-stage exchange, particular attention was paid to the type of spacer: articulating or static.In all, 32 articles were analysed: 14 articles for single-stage including 687 patients and 18 articles for double-stage including 1086 patients. The average eradication rate was 87.1% for the one-stage procedure and 84.8% for the two-stage procedure. The functional outcomes were similar in both groups: the average Knee Society Knee Score was 80.0 in the single-stage exchange group and 77.8 in the double-stage exchange. The average range of motion was 91.4° in the single-stage exchange group and 97.8° in the double-stage exchange group.Single-stage exchange appears to be a viable alternative to two -stage exchange in cases of chronic periprosthetic joint infection around the knee, provided there are no contra-indications, producing similar results in terms of eradication rates and functional outcomes, and offering the advantage of a unique surgical procedure, lower morbidity and reduced costs. Cite this article: 2019;4:495-502. DOI: 10.1302/2058-5241.4.190003.

Citing Articles

Short-term follow-up of antibiotic-loaded calcium sulfate in treating chronic periprosthetic joint infection during two-stage revision.

Sun X, Tan J, Zhan L, Sheng M, Tang Z, Wu L Front Bioeng Biotechnol. 2025; 13:1352895.

PMID: 39949390 PMC: 11821931. DOI: 10.3389/fbioe.2025.1352895.

Outcomes of Unrestricted Weight-Bearing During Interval Period With Cement-on-Cement Articulating Antibiotic-Loaded Spacers in Two-Stage Revision for Knee Prosthetic Joint Infection.

Uehara K, Shiigi E, Seki K, Imagama T, Seki T, Tanaka H Cureus. 2025; 16(12):e75404.

PMID: 39781142 PMC: 11710874. DOI: 10.7759/cureus.75404.

Editorial Comment: Selected Proceedings From the 2023 Musculoskeletal Tumor Society Meeting.

Temple H Clin Orthop Relat Res. 2025; 483(1):37-38.

PMID: 39746133 PMC: 11658721. DOI: 10.1097/CORR.0000000000003301.

Long-Term Outcome of Treating Periprosthetic Hip Joint Infection with Local Antibiotics Delivered Through Antibiotic-Impregnated Calcium Hydroxyapatite.

Wakabayashi H, Hasegawa M, Naito Y, Tone S, Sudo A J Clin Med. 2024; 13(23).

PMID: 39685927 PMC: 11642245. DOI: 10.3390/jcm13237469.

What Are the Research Highlights of Periprosthetic Joint Infections From the 100 Most Cited Studies?.

Gonzalez M, Acosta J, Davis J, Larios F, Olsen A, Chen A Arthroplast Today. 2024; 30:101564.

PMID: 39559547 PMC: 11570763. DOI: 10.1016/j.artd.2024.101564.

References

Fehring T, Odum S, Calton T, Mason J . Articulating versus static spacers in revision total knee arthroplasty for sepsis. The Ranawat Award. Clin Orthop Relat Res. 2000; (380):9-16. DOI: 10.1097/00003086-200011000-00003. View

Goldstein W, Kopplin M, Wall R, Berland K . Temporary articulating methylmethacrylate antibiotic spacer (TAMMAS). A new method of intraoperative manufacturing of a custom articulating spacer. J Bone Joint Surg Am. 2001; 83-A Suppl 2 Pt 2:92-7. View

Siebel T, Kelm J, Porsch M, Regitz T, Neumann W . Two-stage exchange of infected knee arthroplasty with an prosthesis-like interim cement spacer. Acta Orthop Belg. 2002; 68(2):150-6. View

Silva M, Tharani R, Schmalzried T . Results of direct exchange or debridement of the infected total knee arthroplasty. Clin Orthop Relat Res. 2002; (404):125-31. DOI: 10.1097/00003086-200211000-00022. View

Buechel F, Femino F, DAlessio J . Primary exchange revision arthroplasty for infected total knee replacement: a long-term study. Am J Orthop (Belle Mead NJ). 2004; 33(4):190-8. View

Blom A, Brown J, Taylor A, Pattison G, Whitehouse S, Bannister G . Infection after total knee arthroplasty. J Bone Joint Surg Br. 2004; 86(5):688-91. DOI: 10.1302/0301-620x.86b5.14887. View

Durbhakula S, Czajka J, Fuchs M, Uhl R . Antibiotic-loaded articulating cement spacer in the 2-stage exchange of infected total knee arthroplasty. J Arthroplasty. 2004; 19(6):768-74. DOI: 10.1016/j.arth.2004.02.036. View

Hofmann A, Goldberg T, Tanner A, Kurtin S . Treatment of infected total knee arthroplasty using an articulating spacer: 2- to 12-year experience. Clin Orthop Relat Res. 2005; (430):125-31. DOI: 10.1097/01.blo.0000149241.77924.01. View

Cuckler J . The infected total knee: management options. J Arthroplasty. 2005; 20(4 Suppl 2):33-6. DOI: 10.1016/j.arth.2005.03.004. View

10.

Jamsen E, Sheng P, Halonen P, Lehto M, Moilanen T, Pajamaki J . Spacer prostheses in two-stage revision of infected knee arthroplasty. Int Orthop. 2006; 30(4):257-61. PMC: 2532134. DOI: 10.1007/s00264-006-0102-2. View

11.

Laffer R, Graber P, Ochsner P, Zimmerli W . Outcome of prosthetic knee-associated infection: evaluation of 40 consecutive episodes at a single centre. Clin Microbiol Infect. 2006; 12(5):433-9. DOI: 10.1111/j.1469-0691.2006.01378.x. View

12.

Bauer T, Piriou P, Lhotellier L, Leclerc P, Mamoudy P, Lortat-Jacob A . [Results of reimplantation for infected total knee arthroplasty: 107 cases]. Rev Chir Orthop Reparatrice Appar Mot. 2006; 92(7):692-700. DOI: 10.1016/s0035-1040(06)75930-x. View

13.

Huang H, Su J, Chen S . The results of articulating spacer technique for infected total knee arthroplasty. J Arthroplasty. 2006; 21(8):1163-8. DOI: 10.1016/j.arth.2006.01.028. View

14.

Goksan S, Freeman M . One-stage reimplantation for infected total knee arthroplasty. J Bone Joint Surg Br. 1992; 74(1):78-82. DOI: 10.1302/0301-620X.74B1.1732271. View

15.

Hsu Y, Cheng H, Ng T, Chiu K . Antibiotic-loaded cement articulating spacer for 2-stage reimplantation in infected total knee arthroplasty: a simple and economic method. J Arthroplasty. 2007; 22(7):1060-6. DOI: 10.1016/j.arth.2007.04.028. View

16.

Pulido L, Ghanem E, Joshi A, Purtill J, Parvizi J . Periprosthetic joint infection: the incidence, timing, and predisposing factors. Clin Orthop Relat Res. 2008; 466(7):1710-5. PMC: 2505241. DOI: 10.1007/s11999-008-0209-4. View

17.

Jamsen E, Stogiannidis I, Malmivaara A, Pajamaki J, Puolakka T, Konttinen Y . Outcome of prosthesis exchange for infected knee arthroplasty: the effect of treatment approach. Acta Orthop. 2009; 80(1):67-77. PMC: 2823239. DOI: 10.1080/17453670902805064. View

18.

Bozic K, Kurtz S, Lau E, Ong K, Chiu V, Vail T . The epidemiology of revision total knee arthroplasty in the United States. Clin Orthop Relat Res. 2009; 468(1):45-51. PMC: 2795838. DOI: 10.1007/s11999-009-0945-0. View

19.

Parvizi J, Pawasarat I, Azzam K, Joshi A, Hansen E, Bozic K . Periprosthetic joint infection: the economic impact of methicillin-resistant infections. J Arthroplasty. 2010; 25(6 Suppl):103-7. DOI: 10.1016/j.arth.2010.04.011. View

20.

Mortazavi S, Vegari D, Ho A, Zmistowski B, Parvizi J . Two-stage exchange arthroplasty for infected total knee arthroplasty: predictors of failure. Clin Orthop Relat Res. 2011; 469(11):3049-54. PMC: 3183212. DOI: 10.1007/s11999-011-2030-8. View