title: Two-stage revision of septic knee prosthesis with articulating knee spacers yields better infection eradication rate than one-stage or two-stage revision with static spacers.
abstract: OBJECTIVE
  The best method for treating chronic periprosthetic knee infection remains controversial. Randomized, comparative studies on treatment modalities are lacking. This systematic review of the literature compares the infection eradication rate after two-stage versus one-stage revision and static versus articulating spacers in two-stage procedures.
  
  
  METHODS
  We reviewed full-text papers and those with an abstract in English published from 1966 through 2011 that reported the success rate of infection eradication after one-stage or two-stage revision with two different types of spacers.
  
  
  RESULTS
  In all, 6 original articles reporting the results after one-stage knee exchange arthoplasty (n = 204) and 38 papers reporting on two-stage revision (n = 1,421) were reviewed. The average success rate in the eradication of infection was 89.8% after a two-stage revision and 81.9% after a one-stage procedure at a mean follow-up of 44.7 and 40.7 months, respectively. The average infection eradication rate after a two-stage procedure was slightly, although significantly, higher when an articulating spacer rather than a static spacer was used (91.2 versus 87%).
  
  
  CONCLUSIONS
  The methodological limitations of this study and the heterogeneous material in the studies reviewed notwithstanding, this systematic review shows that, on average, a two-stage procedure is associated with a higher rate of eradication of infection than one-stage revision for septic knee prosthesis and that articulating spacers are associated with a lower recurrence of infection than static spacers at a comparable mean duration of follow-up.
  
  
  METHODS
  IV.
authors.affiliation: Dipartimento di Chirurgia Ricostruttiva e delle Infezioni Osteo-articolari, Istituto Ortopedico IRCCS Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy. carlo.romano@grupposandonato.it
authors.forename: C L
authors.initials: CL
authors.lastname: Romanò
authors.forename: L
authors.initials: L
authors.lastname: Gala
authors.forename: N
authors.initials: N
authors.lastname: Logoluso
authors.forename: D
authors.initials: D
authors.lastname: Romanò
authors.forename: L
authors.initials: L
authors.lastname: Drago
mesh_terms: D001170:Arthritis, Infectious / Q000209:etiology / Q000601:surgery*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007719:Knee Joint / Q000473:pathology / Q000601:surgery*; D007720:Knee Prosthesis / Q000382:microbiology*; D019637:Orthopedic Procedures / Q000379:methods*; D016459:Prosthesis-Related Infections / Q000601:surgery*; D012086:Reoperation / Q000379:methods; D016896:Treatment Outcome