title: Two-Stage Revision TKA Is Associated with High Complication and Failure Rates.
abstract: Despite two-stage revision remaining the gold standard in treating periprosthetic infection of total knee arthroplasty (TKA), there remains uncertainty regarding the actual success rate and the risk factors for failure. We retrospectively reviewed 58 knees with mean follow-up of 38 months who underwent two-stage revision TKAs from 1998 to 2012 by a single surgeon. Failure was defined as persistent infection or reoperation after two-stage revision TKA surgery. Failure occurred in 36%. The overall mortality was 22%. The mean time to reinfection was 26 months. Polymicrobial infection was associated with a higher risk of failure (RR 3.31, P < 0.001). Knees requiring soft tissue coverage were also at a greater risk of failure (RR 2.67, P = 0.001), as were knees that underwent four or more additional surgeries after the primary TKA and prior to stage-one explantation (RR 2.25, P = 0.020). Thus, opportunities exist for improvement in management of infected TKA.
authors.affiliation: Department of Orthopaedic Surgery, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA.
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Pelt
authors.affiliation: Department of Orthopaedic Surgery, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA.
authors.forename: Ray
authors.identifier: 0000-0003-2099-3276
authors.initials: R
authors.lastname: Grijalva
authors.affiliation: Department of Orthopaedic Surgery, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA.
authors.forename: Lucas
authors.identifier: 0000-0002-9855-337X
authors.initials: L
authors.lastname: Anderson
authors.affiliation: Department of Orthopaedic Surgery, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA.
authors.forename: Mike B
authors.initials: MB
authors.lastname: Anderson
authors.affiliation: Department of Orthopaedic Surgery, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA.
authors.forename: Jill
authors.identifier: 0000-0001-8323-6112
authors.initials: J
authors.lastname: Erickson
authors.affiliation: Department of Orthopaedic Surgery, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Peters