title: Outcome of prosthesis exchange for infected knee arthroplasty: the effect of treatment approach.
abstract: OBJECTIVE
  Two-stage revision remains the gold standard in the treatment of infected knee arthroplasty. Lately, good long-term results of direct exchange arthroplasty have been reported. The purpose of this literature review is to compare the clinical outcome achieved with one-stage revision and two-stage revision with different types of spacers.
  
  
  METHODS
  A thorough systematic review of literature was undertaken to idenepsy reports on the treatment alternatives. Papers written in English or including an English abstract, published from 1980 through 2005, and reporting either the success rate in eradication of infection or the clinical status achieved were reviewed. 31 original articles describing the results of 154 one-stage exchange arthoplasties and of 926 two-stage exchange arthoplasties were included. The depth of detail in the description of materials and methods varied markedly, making it impossible to perform a meta-analysis. Instead, a descriptive review of the results is presented.
  
  
  RESULTS
  With a follow-up of 12-122 months, the overall success rate in eradication of infection was 73-100% after one-stage revisions and 82-100% after two-stage revisions. Reinfection rates were the lowest in series where articulating cement spacers were used, though the follow-up was relatively short. Studies using articulating spacers reported the highest average postoperative ranges of motion. Otherwise, no correlations were observed between the clinical outcome and the length of follow-up, the type of revision, or the type of spacer. The clinical outcome (knee scores and range of motion) of the one-stage revisions was no different from that of the two-stage revisions.
  
  
  CONCLUSIONS
  Two-stage exchange is an effective treatment. Mobile spacers may further improve the range of motion. More experience in one-stage revision is required in order to define its role in the management of infected knee arthroplasties.
authors.affiliation: Medical School, University of Tampere, Tampere, Finland.
authors.forename: Esa
authors.initials: E
authors.lastname: Jämsen
authors.forename: Ioannis
authors.initials: I
authors.lastname: Stogiannidis
authors.forename: Antti
authors.initials: A
authors.lastname: Malmivaara
authors.forename: Jorma
authors.initials: J
authors.lastname: Pajamäki
authors.forename: Timo
authors.initials: T
authors.lastname: Puolakka
authors.forename: Yrjö T
authors.initials: YT
authors.lastname: Konttinen
mesh_terms: D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000379:methods; D006801:Humans; D007720:Knee Prosthesis / Q000009:adverse effects; D017063:Outcome Assessment, Health Care; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000382:microbiology / Q000601:surgery*; D016059:Range of Motion, Articular; D012008:Recurrence; D012086:Reoperation