Satisfactory and Similar Outcomes After Knee Arthroplasty Revisions in One or Two Stages for Infection, Following a Surgical Strategy Based on Robust Guidelines.

Abstract

This study aimed to assess the outcomes of a one-stage or two-stage strategy after revision total knee arthroplasty for periprosthetic joint infection. This single-center retrospective study included all TKA revisions for chronic infection operated on between 2010 and 2021, with at least two years of follow-up. The surgical strategy was based on the recommendations from the Philadelphia Consensus 2018. Patients were classified into five overlapping groups: mechanical failure, septic failure, controlled infection, cure of infection, and complete healing. Revision was defined as the need for further surgery with implant removal. There were 218 revision total knee arthroplasties included, with 182 two-stage revisions (83.5%) and 36 one-stage revisions (16.5%). The mean follow-up was 56.9 ± 30.8 months. At the last follow-up, 135 patients (61.9%) were classified as "complete healing," 30 as "septic failure" (13.8%), 12 as "mechanical failure" (5.5%), 147 (67.4%) as "infection-cured," and 41 (18.8%) as "controlled infection." There were 27 patients (14.8%) who had septic failure, and 11 (6.1%) had mechanical failure in the two-stage group, versus three (8.3%) and one (2.8%), respectively, in the one-stage group (P = 0.36). There were 128 "R2" or "complex revision cases" (58.7%) and 90 "R3" or "salvage cases" (41.3%) according to the revision knee complexity classification. In multivariate analysis, the requirement of a flap (odds ratio [OR] = 0.28, [0.11 to 0.72]), revision knee complexity classification grade of R3 (OR = 0.37, [0.21 to 0.68]), and an American Society of Anesthesiologists score >2 (OR = 0.51, [0.28 to 0.93]) were associated with lower rates of infection healing. Following a surgical strategy based on robust guidelines, one- or two-stage TKA revision for periprosthetic joint infection achieved satisfactory rates of complete healing and cure of infection despite 41% of very complex cases. Patients classified as R3, those requiring a flap, and those who had an American Society of Anesthesiologists score greater than 2 were at higher risk of failure. III.