High infection control rate and function after routine one-stage exchange for chronically infected TKA.
BACKGROUND
Many surgeons consider two-stage exchange the gold standard for treating chronic infection after TKA. One-stage exchange is an alternative for infection control and might provide better knee function, but the rates of infection control and levels of function are unclear.


OBJECTIVE
We asked whether a one-stage exchange protocol would lead to infection control rates and knee function similar to those after two-stage exchange.


METHODS
We followed all 47 patients with chronically infected TKAs treated with one-stage exchange between July 2004 and February 2007. We monitored for recurrence of infection and obtained Knee Society Scores. We followed patients a minimum of 3 years or until death or infection recurrence.


RESULTS
Three of the 47 patients (6%) experienced a persistence or recurrence of the index infection with the same pathogen isolated. Three patients (6%) had control of the index infection but between 6 and 17 months experienced an infection with another pathogen. The 3-year survival rates were 87% for being free of any infection and 91% for being healed of the index infection. Twenty-five of the 45 patients (56%) had a Knee Society Score of more than 150 points.


CONCLUSIONS
While routine one-stage exchange was not associated with a higher rate of infection recurrence failure, knee function was not improved compared to that of historical patients having two-stage exchange. One stage-exchange may be a reasonable alternative in chronically infected TKA as a more convenient approach for patients without the risks of two operations and hospitalizations and for reducing costs. The ideal one stage-exchange candidate should be identified in future studies.
Center for Orthopedic and Hand Surgery, University Hospital of Strasbourg, 10 Avenue Baumann, F-67400 Illkirch, France. jean-yves.jenny@chru-strasbourg.fr
Jean-Yves
JY
Jenny
Bruno
B
Barbe
Jeannot
J
Gaudias
Cyril
C
Boeri
Jean-Noël
JN
Argenson
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D003646:Debridement; D020878:Device Removal; D005260:Female; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007719:Knee Joint / Q000601:surgery; D007720:Knee Prosthesis; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000188:drug therapy* / Q000517:prevention & control / Q000601:surgery; D012189:Retrospective Studies; D055502:Secondary Prevention; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents