Background

The efficacy of one stage knee limb salvage procedures over the two-stage alternative is still under contention. The conventional treatment for periprosthetic joint infections (PJI) of the knee is the two-stage revision requiring the use of an antibiotic loaded spacer followed by a delayed exchange. Our question is whether single-stage revisions of infected total knees result provides comparable or possibly better patient outcomes to those reported for two-stage revisions.

Methods

We retrospectively reviewed 376 cases of one-stage revisions of knees between 2005-2018. Patient comorbidities, which included both local and systemic compromises, were reviewed for all patients using McPherson’s classification system for PJIs and patients were subsequently staged. All patients in our cohort presented with PJI of the knee and subsequently underwent a one stage revision using dual setup with radical debridement, definitive knee reconstruction with antibiotic loaded cement and implantation of antibiotic loaded calcium sulfate hemihydrate pellets. Successful treatment was defined as a knee joint without recurrence of infection, for a minimum of 2 years, and limb preservation.

Results

The patients in this cohort had a mean follow-up of 60 months (range: 24 months–14 years) and mean patient age of 61 years old, consisting of 194 males and 182 females. Almost all of the patients were classified as Cierny-Mader type IV BLS borderline C- host or McPherson type III-C-3. 104 out of the 385 patients required flaps; 16 local flaps and 98 free muscle flaps. 54 patients had some form of recurrence. Of the 44 patients that recurred, 14 required an amputation. All patients who had a recurrence of infection presented with draining sinus tracts with dislocations (18%) and wound healing problems (27%) being a major contributing factor.

Conclusion

A one-stage treatment of the knee is more cost-effective and is not associated with some of the physically debilitating complications seen in patients treated with two-stage revision. Based on our findings, one-stage revision of PJIs demonstrates at least as good an infection eradication rate as two-stage revision: 88% compared to 85%. With added advancements to antibiotic delivery mechanisms, we believe that the one stage treatment for total knees will be a more popular treatment option for patients with PJI.