RESULTS OF TWO-STAGE REIMPLANTATION IN PATIENTS WITH PERIPROSTHETIC JOINT INFECTION AFTER TOTAL KNEE ARTHROPLASTY

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Abstract

Treatment of chronic periprosthetic joint infection (PJI) is connected with high reinfection rate and financial costs. Two stage reimplantation with the use of dynamic and static spacers on the first stage is an effective treatment algorithm of such complication.

Purpose of the study – to evaluate the influence of a spacer type on infection eradication and intraoperative features of two-stage surgical treatment in patients with PJI after TKA.

Material and methods. From year 2007 to 2015 161 patients with PJI were treated: 80 patients with dynamic spacers and 81 – with static spacers. The mean follow up period was 65 months (95% CI: 12–91). The mean age was 62 years (95% CI: 30–84). The outcomes included analysis of infection eradication effectiveness and intraoperative features (operation time, blood loss, type of implant). We excluded 57 patients with severe bone defects (AORI 2B, 3), reinfection after the first stage and, finally, analyzed 104 patients with appropriate including criteria.

Results. Effectiveness of the first stage was 70,1%. The second stage demonstrated 90,1% effectiveness. There was statistically lower reinfection rate after the first stage in patients treated with dynamic spacer 88,1%, compared with 59.1% in patients with static spacers. The mean period between stages was 196 days. Sanation surgery with further implantation of dynamic spacer was followed by statistically (p<0,02) lower blood loss – 522.6 ml (95% CI: 150–1300), compared with static spacers – 727.8 ml (698,1 ml (95% CI; 300–1600), but the operation time was comparable (p = 0.8): 140.2 (95% CI; 75–240) и 142.9 min (95% CI: 85–210) respectively. Revision knee arthroplasty after static spacer was followed by frequent (р<0.05) use of extended surgical approach, constrained implants (p<0,05) and long operation time (p<0.02) compared with dynamic constructions.

Conclusion. Two stage reimplantation with the use of dynamic spacers provides better infection control, knee function between stages, less traumatic sanation and revision knee arthroplasty. Inability to comply recommended interval between stages, due to specifics of financing, makes the implantation of dynamic spacers in patients with PJI on the first stage more preferable.

About the authors

P. M. Preobrazhensky

Vreden Russian Research Institute of Traumatology and Orthopedics

Author for correspondence.
Email: p.reobrazhensky@gmail.com

Petr M. Preobrazhensky – Assistance Researcher 

8, ul. Akad. Baykova, St. Petersburg, 195427

Russian Federation

S. A. Bozhkova

Vreden Russian Research Institute of Traumatology and Orthopedics

Email: fake@neicon.ru

Svetlana A. Bozhkova – Dr. Sci. (Med.), Head of the Research Department of Prevention and Treatment of Wound Infection and Department of Clinical Pharmacology 

8, ul. Akad. Baykova, St. Petersburg, 195427

Russian Federation

A. V. Kazemirsky

Vreden Russian Research Institute of Traumatology and Orthopedics

Email: fake@neicon.ru

Alexander V. Kazemirsky – Cand. Sci. (Med.), Orthopedic surgeon 

8, ul. Akad. Baykova, St. Petersburg, 195427

Russian Federation

M. Yu. Goncharov

Vreden Russian Research Institute of Traumatology and Orthopedics

Email: fake@neicon.ru

Maxim Yu. Goncharov – Cand. Sci. (Med.), Head of the department N 5 

8, ul. Akad. Baykova, St. Petersburg, 195427

Russian Federation

References

  1. Ахтямов И.Ф., Римашевский Д.В., Курмангалиев Е.Д.Т., Молдакулов Ж.М., Еремин И.К. Профилактика инфекционных осложнений эндопротезирования коленного сустава. Практическая медицина. 2014;(4-2):23-28.
  2. Божкова С.А., Тихилов Р.М., Разоренов В.Л., Чуприс В.Г., Петрова Т.М. Микробиологические аспекты антибактериальной терапии парапротезной инфекции, вызванной грамположительными возбудителями Инфекции в хирургии. 2011;9(3):31-36.
  3. Васюк С.В. Васильчишин Я.Н., Васюк В.П., Усовершенствованная технология двухэтапного ревизионного эндопротезирования тазобедренного и коленного суставов с применением цементно-антимикробных спейсеров. Вicник ортопедii, травматологii та протезування. 2013;(3):43-49.
  4. Корнилов Н.Н., Куляба Т.А., Филь А.С., Муравьёва Ю.В. Данные регистра эндопротезирования коленного сустава РНИИТО им. Р.Р. Вредена за 2011–2013 годы. Травматология и ортопедия России. 2015;(1):136-151.
  5. Мурылев В.Ю., Холодаев М.Ю., Рукин Я.А., Лычагин А.В., Карпов В.В., Римашевский Д.В., Елизаров П.М. Применение спейсеров для лечения глубокой перипротезной инфекции тазобедренного и коленного суставов. Вестник травматологии и ортопедии им. Н.Н. Приорова. 2013;(3):18-24.
  6. Bengtson S., Knutson K. The infected knee arthroplasty. A 6-year follow-up of 357 cases. Acta Orthop Scand. 1991;62(4):301-311.
  7. Buechel F.F., Femino F.P., D’Alessio J. Primary exchange revision arthroplasty for infected total knee replacement: a long-term study. Am J Orthop (Belle Mead NJ). 2004;33(4):190-198; discussion 198.
  8. Castelli C.C., Gotti V., Ferrari R. Two-stage treatment of infected total knee arthroplasty: two to thirteen year experience using an articulating preformed spacer. Int Orthop. 2014;38(2):405-412. doi: 10.1007/s00264-013-2241-6.
  9. Chen Y.-P., Wu C.-C., Ho W.-P. Autoclaved metal-on-cement spacer versus static spacer in two-stage revision in periprosthetic knee infection. Ind J Orthop. 2016;50(2):146-153. doi: 10.4103/0019-5413.177587.
  10. Emerson R.H. Jr, Muncie M., Tarbox T.R., Higgins L.L. Comparison of a static with a mobile spacer in total knee infection. Clin Orthop Relat Res. 2002;(404):132-138.
  11. Fehring T.K., Odum S., Calton T.F., Mason J.B. Articulating versus static spacers in revision total knee arthroplasty for sepsis. The Ranawat Award. Clin Orthop Relat Res. 2000;(380):9-16.
  12. Goldman R.T., Scuderi G.R., Insall J.N. 2-stage reimplantation for infected total knee replacement. Clin Orthop Relat Res. 1996;(331):118-124.
  13. Haddad F.S., Masri B.A., Campbell D., McGraw R.W., Beauchamp C.P., Duncan C.P. The PROSTALAC functional spacer in two-stage revision for infected knee replacements. Prosthesis of antibiotic-loaded acrylic cement. J Bone Joint Surg Br. 2000;82(6):807-812.
  14. K oh I.J., Cho W.S., Choi N.Y., Kim T.K. Kleos Korea Research Group. Causes, risk factors, and trends in failures after TKA in Korea over the past 5 years: a multicenter study. Clin Orthop Relat Res. 2014;472(1):316-326. doi: 10.1007/s11999-013-3252-8.
  15. Le D.H., Goodman S.B., Maloney W.J., Huddleston J.I. Current modes of failure in TKA: infection, instability, and stiffness predominate. Clin Orthop Relat Res. 2014;472(7):2197-2200. doi: 10.1007/s11999-014-3540-y.
  16. Levy D.M., Wetters N.G., Levine B.R. Prevention of Periprosthetic Joint Infections of the Hip and Knee. Am J Orthop (Belle Mead NJ). 2016;45(5):E299-307.
  17. Lichstein P., Su S., Hedlund H., Suh G., Maloney W.J., Goodman S.B., Huddleston J.I. 3rd. Treatment of Periprosthetic Knee Infection With a Two-stage Protocol Using Static Spacers. Clin Orthop Relat Res. 2016;474(1):120-125. doi: 10.1007/s11999-015-4443-2.
  18. Park S.J., Song E.K., Seon J.K., Yoon T.R., Park G.H. Comparison of static and mobile antibiotic-impregnated cement spacers for the treatment of infected total knee arthroplasty. Int Orthop. 2010;34(8):1181-1186. doi: 10.1007/s00264-009-0907-x.
  19. Parvizi J., Azzam K., Ghanem E., Austin M.S., Rothman R.H. Periprosthetic infection due to resistant staphylococci: serious problems on the horizon. Clin Orthop Relat Res. 2009;467(7):1732-1739. doi: 10.1007/s11999-009-0857-z.
  20. Parvizi J., Gehrke T., Chen A.F. Proceedings of the International Consensus on Periprosthetic Joint Infection. Bone Joint J. 2013;95-B(11):1450-1452. doi: 10.1302/0301-620X.95B11.33135.
  21. Sharkey P.F., Hozack W.J., Rothman R.H., Shastri S., Jacoby S.M. Why are total knee arthroplasties failing today? Clin Orthop Relat Res. 2002;404:7-13. doi: 10.1097/00003086-200211000-00003.
  22. Silvestre A., Almeida F., Renovell P., Morante E. Lopez R. Revision of infected total knee arthroplasty: two-stage reimplantation using an antibiotic-impregnated static spacer. Clin Orthop Surg. 2013;5(3):180-187. doi: 10.4055/cios.2013.5.3.180.
  23. Vasso M., Del Regno C., Corona K., D’Apolito R., Schiavone Panni A. Articulated spacer provides long-term knee improvement after two-stage reimplantation. Knee Surg Sports Traumatol Arthrosc. 2016;24(10):3100-3105. doi: 10.1007/s00167-016-4238-3.

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