The outcomes of surgical management of failed two-stage revision knee arthroplasty

Carla  Maden; Monketh Jaibaji; Sujith  Konan; Luigi  Zagra; Matteo Borella; Adrian Harvey; Andrea  Volpin

doi:10.23750/abm.v92i3.10956

The outcomes of surgical management of failed two-stage revision knee arthroplasty

Authors

Carla Maden West Middlesex University Hospital, London, UK
Monketh Jaibaji a:1:{s:5:"en_US";s:24:"Royal Victoria Infirmary";}
Sujith Konan Department of trauma and Orthopaedics, University College Hospital, London
Luigi Zagra Department Trauma and Orthopaedic, Istituto Ortopedico Galeazzi IRCCS, Milan, Italy
Matteo Borella Department Trauma and Orthopaedic, Azienda ULSS 1 Dolomiti, Belluno, Italy
Adrian Harvey 6- Department Trauma and Orthopaedics, Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth, UK
Andrea Volpin 7- Department Trauma and Orthopaedics, NHS Grampian, Elgin, UK

DOI: https://doi.org/10.23750/abm.v92i3.10956

Keywords:

Two stage knee arthroplasty, Joint infection, recurrence, revision arthroplasty

Abstract

Background

Joint infection following total knee arthroplasty has significant consequences on both the patient and healthcare system. Two stage revision arthroplasties is viewed as the gold standard in management. However, recurrence of infection following this procedure is a growing clinical problem for a multitude of reasons.

Despite a variety of surgical options for management of failure of two-stage revision arthroplasty, the potential for complications and functional limitation remains high, and the optimal strategy is yet to be determined.

Methods

We performed a systematic review of all papers reporting on the outcomes of the surgical management of failure of two-stage revision arthroplasty published up to and including January 2020. Data was extracted on patient demographics, study design, methodological quality, indication for surgery, surgical technique, clinical and functional outcomes, and complications.

Results

Nine papers with a total of 273 patients were found and analysed All surgical techniques had mixed results in term of clinical and functional outcomes, and the rate of complications was high in all studies. Knee arthrodesis had the lower risk of failure than repeat 2 stage revision. Poor patient immunological status and limb status were weakly associated with increased risk of failure.

Conclusion

Despite failure of two-stage revision arthroplasty being a growing clinical issue, we were not able to identify any consistently superior surgical technique for the management of this scenario. Knee arthrodesis appears to provide the best results for improving quality of life and reducing infection recurrence, although the complication rate is high and the functional outcomes appear to be worse. Further larger and prospective studies are needed to elucidate optimal surgical management in different patient subsets.

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