2025 ISAKOS Biennial Congress ePoster
Success Rate Of Two-Stage Knee Revision Arthroplasty Using A Static Spacer: A 10-Year Single Center Cohort Of 270 Patients.
Stavros Goumenos, MD, PhD, Athens GREECE
Olga Pidgaiska, MD, PhD, Berlin GERMANY
Domenico De Mauro, MD ITALY
Jobst Leopold Hansberg, MD, Berlin GERMANY
Moritz Mewes, MD, Berlin GERMANY
Konstantinos Degiannis, MD, Berlin GERMANY
Stephanie Kirschbaum, MD, Berlin GERMANY
Clemens Gwinner, MD, Berlin GERMANY
Andrej Trampuz, Prof., Brisbane, QLD AUSTRALIA
Ulrich C Stöckle, MD, Univ-Prof, Tübingen GERMANY
Carsten Perka, MD, PhD, Berlin GERMANY
Sebastian Meller, MD, Berlin GERMANY
Center for Musculoskeletal Surgery, Campus Virchow Klinikum, Charite, Berlin, Germany, Berlin, GERMANY
FDA Status Not Applicable
Summary
Reinfection rates after 2-stage TKA revision for PJI still remain high, especially in high-comorbidity hosts with multiple prior septic re-operations.
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Abstract
Background
Two-stage knee implant exchange with the use of static antibiotic-loaded cement spacers has been one of the most popular and effective strategies to manage periprosthetic joint infections (PJIs) of a total knee arthroplasty (TKA). Even so, the treatment failure rates are high and the identification and modification of risk factors for reinfection has never been more crucial.
Objective
The aims of our study were (1) to determine the success rate of 2-stage TKA revision for the treatment of PJI and (2) to evaluate relevant risk factors for reinfection after reimplantation.
Methods
We conducted a retrospective analysis of a prospective cohort of 270 patients who underwent a 2-stage TKA revision after being diagnosed with PJI from 2013 to 2023. All patients were treated with a static antibiotic-loaded cement arthrodesis spacer using two interconnecting intramedullary rods. The median interval duration was 9 weeks (range, 5 to 29) and the median duration of follow-up was 57 months (range, 12 to 106). Treatment success was defined as infection-free outcome after the 2nd stage reimplantation.
Results
The overall reinfection rate after reimplantation in our cohort was 17% (45/270) in an average time-to-reinfection of 18 months. An additional 23 patients (9%) required at least one interim spacer exchange before reimplantation. The majority of the reinfections (67%) were caused by a different pathogen. The re-implanted prostheses were rotation-hinged implants in 160/270 patients (60%), valgus/varus constrained implants in 71/270 patients (26%) and tumor prostheses in 22/270 patients (8%). Fourteen percent of our patients remained in a temporary knee arthrodesis state. A higher number of prior septic knee revision surgeries, difficult-to-treat microorganisms (especially fungal infections), a higher local extremity grade and a higher comorbidity host type were found to be significant factors for treatment failure after univariate analysis. These findings are being analyzed at present also through a multivariate regression model.
Conclusion
Reinfection rates after 2-stage TKA revision for PJI still remain high, especially in high comorbidity hosts with multiple prior septic re-operations.