title: Eradication rates, risk factors, and implant selection in two-stage revision knee arthroplasty: a mid-term follow-up study.
abstract: BACKGROUND
  Two-stage revision (TSR) knee arthroplasty is an established treatment, but failure to control infection still occurs in 4-50 % of cases. The aim of this study was to assess the infection eradication rate, risk factors for failure, and the clinical outcome after two-stage revision knee arthroplasty.
  
  
  METHODS
  This retrospective study included 59 patients who had undergone at least one two-stage revision procedure due to periprosthetic joint infection (PJI). Demographic data, comorbidities, types of implant, and complications were analyzed. Univariate and multivariate logistic regression analysis were used to identify risk factors for failure.
  
  
  RESULTS
  The infections were controlled in 55 patients (93.2 %). The follow-up period was 4.1 (±2.7) years. Infection control was achieved after the first TSR in 42 patients (71.2 %) and after the second TSR in 13 (76.5 %). The percentage of arthrodesis procedures in patients with infection control increased from 16.75 % after one TSR to 69.2 % after two TSRs. Multivariate logistic regression analysis identified body mass index (BMI) (odds ratio 1.22; 95 % confidence intervals, 1.07 to 1.40; p = 0.004) and smoking (OR 21.52; 95 % CI, 2.60 to 178.19; p = 0.004) as risk factors for failure.
  
  
  CONCLUSIONS
  Two-stage revision protocols can achieve acceptable results even after a second procedure. It is still unclear whether the choice of implant influences failure rates. Risk factors for failure after two-stage revision were identified. Studies with larger sample sizes are needed in order to support these findings and identify further risk factors. To reduce failure rates, programs should be established to treat or minimize risk factors in patients with PJI.
authors: Department of Orthopaedics, Paracelsus Hospital, Am Natruper Holz 69, 49076, Osnabrück, Germany. st.hoell@web.de.
authors: Steffen
authors: S
authors: Hoell
authors: Department of General Orthopaedics and Tumor Orthopaedics, University Hospital, Albert-Schweitzer-Campus 1, 48149, Münster, Germany.
authors: Anna
authors: A
authors: Sieweke
authors: Department of General Orthopaedics and Tumor Orthopaedics, University Hospital, Albert-Schweitzer-Campus 1, 48149, Münster, Germany.
authors: Georg
authors: G
authors: Gosheger
authors: Department of General Orthopaedics and Tumor Orthopaedics, University Hospital, Albert-Schweitzer-Campus 1, 48149, Münster, Germany.
authors: Jendrik
authors: J
authors: Hardes
authors: Department of General Orthopaedics and Tumor Orthopaedics, University Hospital, Albert-Schweitzer-Campus 1, 48149, Münster, Germany.
authors: Ralf
authors: R
authors: Dieckmann
authors: Department of General Orthopaedics and Tumor Orthopaedics, University Hospital, Albert-Schweitzer-Campus 1, 48149, Münster, Germany.
authors: Helmut
authors: H
authors: Ahrens
authors: Department of General Orthopaedics and Tumor Orthopaedics, University Hospital, Albert-Schweitzer-Campus 1, 48149, Münster, Germany.
authors: Arne
authors: A
authors: Streitbuerger
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D060740:Disease Eradication / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D012086:Reoperation / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D012307:Risk Factors
keywords: Arthrodesis; BMI; Nicotine abuse; Periprosthetic joint infection; Risk factor; Two-stage revision knee arthroplasty