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. 2023 Feb;143(2):987-994.
doi: 10.1007/s00402-022-04594-z. Epub 2022 Aug 18.

Repeat revision TKR for failed management of peri-prosthetic infection has long-term success but often require multiple operations: a case control study

Harshad Rajgor  1 , Huan Dong  1 , Raj Nandra  1 , Michael Parry  2   3 , Jonathan Stevenson  4   5 , Lee Jeys  2   6
Affiliations

Repeat revision TKR for failed management of peri-prosthetic infection has long-term success but often require multiple operations: a case control study

Harshad Rajgor et al. Arch Orthop Trauma Surg. 2023 Feb.

Abstract

Background: Prosthetic joint infection (PJI) is associated with poor outcomes and catastrophic complications. The aim of this study was to present the outcomes of re-revision surgery for PJI of the knee following previous failed two-stage exchange arthroplasty.

Materials and methods: A retrospective analysis was performed of 32 patients who underwent re-revision knee arthroplasty, having already undergone at least one previous two-stage exchange for PJI with a minimum follow-up of two-years for alive patients. Outcomes were compared to a matched control of two-stage revisions for PJI of a primary knee replacement also containing 32 patients. Outcomes investigated were eradication of infection, re-operation, mortality and limb-salvage rate.

Results: Successful eradication of infection was achieved in 50% of patients following re-revision surgery, compared with 91% following two-stage exchange of primary knee replacement for PJI (p < 0.001). Fourteen (44%) patients required further re-operation compared with three (9%) patients in the primary group (p = 0.006). Amputation was performed in one case (3%) with thirteen patients (92%) who had infection controlled by debridement, antibiotics and implant retention (DAIR), further revision surgery or arthrodesis. Two patients died with infection (6%) and the long-term rate for infection control was 91%. The mean number of procedures following surgery for the re-revision group was 2.8 (0-9) compared with 0.13 (0-1) for the primary two-stage group (p < 0.001). Five-year patient survival was 90.6% (95% CI 77.1-100). The limb-salvage rate for the re-revision cohort was 97%.

Conclusion: Outcomes for re-revision knee arthroplasty for PJI have higher re-operation and failure rates, but no worse mortality than in revisions of primary knee replacements. Failures can successfully be managed by further operation.

Keywords: Prosthetic joint infection; Revision knee surgery.

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References

    1. No authors listed: National joint registry: 16th Annual report, 2019. https://reports.njrcentre.org.uk/Portals/0/PDFdownloads/NJR%2016th%20Ann...
    1. Kurtz S, Ong K, Lau E, Mowat F, Halpern M (2007) Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 89(4):780–785 - DOI - PubMed
    1. Natsuhara K, Shelton T, Meehan J, Lum Z (2019) Mortality During Total Hip Periprosthetic Joint Infection. J Arthroplasty 34(7S):S337–S342 - DOI - PubMed
    1. Bongers J, Jacobs AME, Smulders K, Van Hellemondt GG, Goosen JHM (2020) Reinfection and re-revision rates of 113 two-stage revisions in infected TKA. J Bone Jt Infect 5(3):137–144 - DOI - PubMed - PMC
    1. Zmistowski B, Karam J, Durinka J, Casper D, Parvizi J (2013) Periprosthetic joint infection increases the risk of one-year mortality. J Bone Joint Surg Am 95(24):2177–2184. https://doi.org/10.2106/JBJS.L.00789 - DOI

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