title: Infection recurrence factors in one- and two-stage total knee prosthesis exchanges.
abstract: OBJECTIVE
  Revision of infected total knee replacements (TKR) is usually delayed for a period in which the joint space is filled with an antibiotic-loaded acrylic spacer. In contrast, one-stage re-implantation supposes immediate re-implantation. Formal comparisons between the two methods are scarce. A retrospective multi-centre study was conducted to investigate the effects of surgery type (one-stage vs. two-stage) on cure rates. It was hypothesised that this parameter would not influence the results.
  
  
  METHODS
  All infected TKR, treated consecutively between 2005 and 2010 by senior surgeons working in six referral hospitals, were included retrospectively. Two hundred and eighty-five patients, undergoing one-stage or two-stage TKR, with more than 2-year follow-up (clinical and radiological) were eligible for data collection and analysis. Of them, 108 underwent one-stage and 177 received two-stage TKR. Failure was defined as infection recurrence or persistence of the same or unknown pathogens. Factors linked with infection recurrence were analysed by uni- and multi-variate logistic regression with random intercept.
  
  
  RESULTS
  Factors associated with infection recurrence were fistulae (odds ratio (OR) 3.4 [1.2-10.2], p = 0.03), infection by gram-negative bacteria (OR 3.3 [1.0-10.6], p = 0.05), and two-stage surgery with static spacers (OR 4.4 [1.1-17.9], p = 0.04). Gender and type of surgery interacted (p = 0.05). In men (133 patients), type of surgery showed no significant linkage with infection recurrence. In women (152 patients), two-stage surgery with static spacers was associated independently with infection recurrence (OR 5.9 [1.5-23.6], p = 0.01). Among patients without infection recurrence, International Knee Society scores were similar between those undergoing one-stage or two-stage exchanges.
  
  
  CONCLUSIONS
  Two-stage procedures offered less benefit to female patients. It suggests that one-stage procedures are preferable, because they offer greater comfort without increasing the risk of recurrence. Routine one-stage procedures may be a reasonable option in the treatment of infected TKR.
  
  
  METHODS
  III.
authors.affiliation: Department of Orthopaedic Surgery, Hôpital Bichat Claude Bernard, Université Paris-Diderot, 46 rue Henri Huchard, 75877, Paris Cedex 18, France. phmassin@gmail.com.|EA 7334 Recherche Clinique Coordonnée Ville-Hôpital, Méthodologies et Société, Université Paris-Diderot, Sorbonne Paris Cité, 75010, Paris, France. phmassin@gmail.com.
authors.forename: P
authors.initials: P
authors.lastname: Massin
authors.affiliation: Department of Epidemiology and Clinical Research, Hôpitaux Universitaires Paris Nord Val de Seine, Site Bichat, 46, rue Henri-Huchard, 75877, Paris Cedex 18, France.|INSERM, CIC-EC 1425, 75018, Paris, France.
authors.forename: T
authors.initials: T
authors.lastname: Delory
authors.affiliation: Groupe Hospitalier Diaconesse Croix Saint Simon, 125 rue d'Avron, 75020, Paris, France.
authors.forename: L
authors.initials: L
authors.lastname: Lhotellier
authors.affiliation: Hôpital Universitaire Roger Salengro, 59037, Lille, France.
authors.forename: G
authors.initials: G
authors.lastname: Pasquier
authors.affiliation: Centre Chirurgical Emile Gallé, 49 rue Hermite, 54000, Nancy, France.
authors.forename: O
authors.initials: O
authors.lastname: Roche
authors.affiliation: Institut Calot, rue du Docteur Calot, 62600, Berck Sur Mer, France.
authors.forename: A
authors.initials: A
authors.lastname: Cazenave
authors.affiliation: Department of Epidemiology and Clinical Research, Hôpitaux Universitaires Paris Nord Val de Seine, Site Bichat, 46, rue Henri-Huchard, 75877, Paris Cedex 18, France.|INSERM, CIC-EC 1425, 75018, Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Estellat
authors.affiliation: Centre de Chirurgie Orthopédique et de la Main, Hôpitaux Universitaires de Strasbourg, 10 Avenue Baumann, 67400, Illkirch-Graffenstaden, France.
authors.forename: J Y
authors.initials: JY
authors.lastname: Jenny
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007719:Knee Joint / Q000601:surgery; D007720:Knee Prosthesis / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000382:microbiology / Q000628:therapy*; D012008:Recurrence; D012086:Reoperation / Q000379:methods*; D012189:Retrospective Studies; D012737:Sex Factors
chemical_list: D000900:Anti-Bacterial Agents
keywords: Infection of the site of operation; Prosthesis joint infection; Prosthetic exchange; Total knee replacement