title: Outcomes of infected revision knee arthroplasty managed by two-stage revision in a tertiary referral centre.
abstract: BACKGROUND
  A two-stage revision remains the gold standard to eradicate deep infection in total knee arthroplasty. Higher failure rates are associated with a number of factors including poly-microbial infections, multiresistant organisms and previous operations. The aims are to investigate [1] the overall success rate of a two-stage revision for infections in TKA, [2] the outcome of repeat two-stage revisions in recurrent infections and [3] the factors affecting the outcomes of such cases.
  
  
  METHODS
  We present the outcomes of a consecutive, retrospective case series of 51 periprosthetic joint infections managed with a two-stage revision knee arthroplasty over a three year period.
  
  
  RESULTS
  Forty-six (90%) of 51 were referred from other hospitals. Infection was successfully eradicated in 24 (65%) of 37 patients undergoing an initial two-stage procedure. Following a failed two-stage revision, a repeat two-stage revision was performed in 19 patients eradicating infection in 8 (42%). A third two-stage was performed in five of these patients eradicating infection in three with an average follow-up of 43 months. Multidrug resistance was present in 69%, and 47% of the patients were infected with multiple organisms. All unsuccessful outcomes involved at least one multidrug-resistant organism compared to 43% in the successful cohort (P=0.0002). Serological markers prior to a second-stage procedure were not significantly different between successful and unsuccessful outcome groups.
  
  
  CONCLUSIONS
  Single or multiple two-stage revisions can eradicate infection despite previous failed attempts. In this series, failure is associated with multidrug resistance, previous failed attempts to eradicate infection and a less favourable host response.
authors.affiliation: Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, London HA7 4LP, United Kingdom. Electronic address: john.stammers@nhs.net.
authors.forename: John
authors.initials: J
authors.lastname: Stammers
authors.affiliation: Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, London HA7 4LP, United Kingdom.
authors.forename: Steven
authors.initials: S
authors.lastname: Kahane
authors.affiliation: Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, London HA7 4LP, United Kingdom.
authors.forename: Vijai
authors.initials: V
authors.lastname: Ranawat
authors.affiliation: Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, London HA7 4LP, United Kingdom.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Miles
authors.affiliation: Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, London HA7 4LP, United Kingdom.
authors.forename: Rob
authors.initials: R
authors.lastname: Pollock
authors.affiliation: Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, London HA7 4LP, United Kingdom.
authors.forename: Richard W J
authors.initials: RW
authors.lastname: Carrington
authors.affiliation: Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, London HA7 4LP, United Kingdom.
authors.forename: Timothy
authors.initials: T
authors.lastname: Briggs
authors.affiliation: Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, London HA7 4LP, United Kingdom.
authors.forename: John A
authors.initials: JA
authors.lastname: Skinner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D019645:Arthroplasty, Replacement, Knee; D001419:Bacteria / Q000187:drug effects / Q000302:isolation & purification; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006801:Humans; D007720:Knee Prosthesis / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000382:microbiology* / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Knee arthroplasty; Knee revision; Periprosthetic joint infection; Two-stage revision