title: Reinfection after two-stage revision for periprosthetic infection of total knee arthroplasty.
abstract: OBJECTIVE
  Limited data exist regarding the long-term results or risk factors for failure after two-stage reimplantation for periprosthetic knee infection. The purpose of this retrospective review was to investigate infection-free implant survival and identify variables associated with reinfection after this procedure. Furthermore, a staging system was evaluated as a possible prognostic tool for patients undergoing two-stage reimplantation of infected total knee arthroplasty (TKA).
  
  
  METHODS
  In this level II, retrospective prognostic study, 368 patients with infected TKA treated with a two-stage revision protocol at our institution between 1998 and 2006 were reviewed. Patients who developed recurrent infection and an equal number of patients randomly selected for the control group were analysed for risk factors associated with treatment failure.
  
  
  RESULTS
  At the most recent follow-up, 58 (15.8%) patients had developed reinfection after the two-stage reimplantation. The median time to reinfection was 1,303 days (3.6 years), with follow-up time ranging from six to 2,853 days (7.8 years). The strongest positive predictors of treatment failure included chronic lymphoedema [hazard ratio (HR) = 2.28, 95% confidence interval (CI) 1.16-4.48; p = 0.02),and revision between resection and definitive reimplantation (HR = 2.13, 95% CI 1.20-3.79; p = 0.01, whereas patients treated with intravenously administered Cefazolin had a significant reduction in recurrent infection rate (HR = 0.48, 95% CI 0.25-0.90; p = 0.02).
  
  
  CONCLUSIONS
  Our findings should be of help in counselling patients regarding their prognosis when faced with two-stage exchange for infected TKA and provide a basis for future comparisons.
authors.affiliation: Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA. Bernd.Kubista@meduniwien.ac.at
authors.forename: Bernd
authors.initials: B
authors.lastname: Kubista
authors.forename: Robert U
authors.initials: RU
authors.lastname: Hartzler
authors.forename: Christina M
authors.initials: CM
authors.lastname: Wood
authors.forename: Douglas R
authors.initials: DR
authors.lastname: Osmon
authors.forename: Arlen D
authors.initials: AD
authors.lastname: Hanssen
authors.forename: David G
authors.initials: DG
authors.lastname: Lewallen
mesh_terms: D000208:Acute Disease; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000379:methods; D002908:Chronic Disease; D006801:Humans; D007249:Inflammation / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D053208:Kaplan-Meier Estimate; D007719:Knee Joint / Q000382:microbiology / Q000473:pathology / Q000601:surgery; D007720:Knee Prosthesis / Q000009:adverse effects*; D008297:Male; D011379:Prognosis; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D012008:Recurrence; D012042:Registries; D012086:Reoperation; D012189:Retrospective Studies; D015996:Survival Rate; D017211:Treatment Failure
chemical_list: D000900:Anti-Bacterial Agents