title: Assessing the gold standard: a review of 253 two-stage revisions for infected TKA.
abstract: BACKGROUND
  Periprosthetic joint infection has been the leading cause of failure following TKA surgery. The gold standard for infection control has been a two-staged revision TKA. There have been few reports on mid- to long-term survivorship, functional outcomes, and fate of patients with a failed two-stage revision TKA.
  
  
  OBJECTIVE
  Therefore, we determined (1) the mid-term survivorship of two-stage revision TKA, (2) the function of patients in whom infection was controlled, and (3) the outcome of patients with a failed two-stage revision due to recurrent infection.
  
  
  METHODS
  We retrospectively reviewed 239 patients who underwent 253 two-stage revision TKAs for periprosthetic infection. There were 239 patients (253 knees), 104 men and 135 women, with a mean age of 70 ± 10 years at the time of two-stage revision and a mean BMI of 31.53 ± 6.74 kg/m2. During followup, we obtained WOMAC and The Knee Society Clinical Rating Scores and radiographs. The minimum followup was 1 year (median, 4 years; range, 1-17 years).
  
  
  RESULTS
  Thirty-three patients experienced a failed two-staged TKA. Sixteen patients experienced failure due to recurrent sepsis. There were 17 failures for aseptic causes.
  
  
  CONCLUSIONS
  The overall infection-free survivorship for two-stage revision TKA was 85% at 5 years and 78% at 10 years.
  
  
  METHODS
  Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Division of Orthopaedic Surgery, University of Western Ontario & London Health Sciences Centre, University Campus, 339 Windermere Road, London, ON, N6A 5A5, Canada. drtahirmahmud@gmail.com
authors.forename: Tahir
authors.initials: T
authors.lastname: Mahmud
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Lyons
authors.forename: Douglas D
authors.initials: DD
authors.lastname: Naudie
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Macdonald
authors.forename: Richard W
authors.initials: RW
authors.lastname: McCalden
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007720:Knee Prosthesis / Q000009:adverse effects*; D008297:Male; D016459:Prosthesis-Related Infections / Q000601:surgery*; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies