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Mishra AS, Kumar S, Singh HK, et al. Two-Stage Primary Arthroplasty in the Infected Native Knee: A Systematic Review and Pooled Analysis. Indian J Orthop. 2021;55(5):1256-1266doi: 10.1007/s43465-021-00402-9.
Mishra, A. S., Kumar, S., Singh, H. K., Panda, I., Cockshott, S., & Tambe, A. (2021). Two-Stage Primary Arthroplasty in the Infected Native Knee: A Systematic Review and Pooled Analysis. Indian journal of orthopaedics, 55(5), 1256-1266. https://doi.org/10.1007/s43465-021-00402-9
Mishra, Arya S, et al. "Two-Stage Primary Arthroplasty in the Infected Native Knee: A Systematic Review and Pooled Analysis." Indian journal of orthopaedics vol. 55,5 (2021): 1256-1266. doi: https://doi.org/10.1007/s43465-021-00402-9
Mishra AS, Kumar S, Singh HK, Panda I, Cockshott S, Tambe A. Two-Stage Primary Arthroplasty in the Infected Native Knee: A Systematic Review and Pooled Analysis. Indian J Orthop. 2021 Apr 13;55(5):1256-1266. doi: 10.1007/s43465-021-00402-9. eCollection 2021 Oct. PMID: 34824727; PMCID: PMC8586282.
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Indian J Orthop. 2021 Apr 13;55(5):1256-1266. doi: 10.1007/s43465-021-00402-9. eCollection 2021 Oct.

Two-Stage Primary Arthroplasty in the Infected Native Knee: A Systematic Review and Pooled Analysis.

Indian journal of orthopaedics

Arya S Mishra, Sachin Kumar, Hemant K Singh, Inayat Panda, Simon Cockshott, Amol Tambe

Affiliations

  1. Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3NE UK.
  2. Bedford Hospital, Kempston Road, Bedford, MK42 9DJ UK.

PMID: 34824727 PMCID: PMC8586282 DOI: 10.1007/s43465-021-00402-9

Abstract

INTRODUCTION: The knee is the commonest native joint to develop an infection. A two-stage primary knee replacement, with an interim stage of debridement and cement spacer application, modelled after two-stage revision for periprosthetic joint infections (PJI) has been reported for the management of chronic infections.

AIMS: To systematically review the literature to find the infection-free survival and outcomes of this operation and explore its indications.

METHODS: PRISMA guidelines were followed for this review. A systematic search of 4 online databases was conducted on 9/8/2020. After reviewing 226 abstracts and applying our selection criteria, 10 papers were selected for full-text review, and 9 included in the final synthesis.

RESULTS: On pooled analysis, an infection-free survival of 95.6% (CI 94.7-96.4) was found at 2 years in 139 knees, which was unchanged over the remainder of the follow-up (Mean 3.9 years). The complication rate after final implantation was 6% in those that did not develop reinfection. The mean pooled Knee Society Score (KSS) and KSS Function score among 70 patients (4 papers) was 83.4 (80.1-89.0) and 76.8 (71.5-78.0), respectively. The mean range of motion among 82 patients (6 papers) was more than 100°.

CONCLUSIONS: Two-stage primary knee replacement is a safe, effective and reliable procedure with good results in the short to medium term. Further studies are required to lay down precise indications and cost-effectiveness of this procedure, in comparison to other strategies for chronic infection. All joint registries should develop methods to identify patients undergoing two-stage procedures, to understand their long-term survival and outcomes.

© Indian Orthopaedics Association 2021.

Keywords: Cement spacer; Infection-free survival; Joint infection; Outcome measures; Septic arthritis; Two-stage primary knee arthroplasty

Conflict of interest statement

Conflict of interestThe authors declare that they have no conflict of interest.

References

  1. Clin Orthop Relat Res. 2002 Nov;(404):226-31 - PubMed
  2. Surg Infect (Larchmt). 2015 Dec;16(6):755-61 - PubMed
  3. Arthroplast Today. 2020 Jun 23;6(3):431-436 - PubMed
  4. PLoS One. 2016 Mar 11;11(3):e0151537 - PubMed
  5. Ann Rheum Dis. 2008 May;67(5):638-43 - PubMed
  6. Clin Orthop Relat Res. 2014 Jul;472(7):2201-7 - PubMed
  7. Epidemiol Infect. 1996 Dec;117(3):423-8 - PubMed
  8. Knee Surg Sports Traumatol Arthrosc. 2016 Oct;24(10):3115-3121 - PubMed
  9. Lancet Infect Dis. 2020 Mar;20(3):341-349 - PubMed
  10. Clin Orthop Relat Res. 1988 Nov;(236):135-40 - PubMed
  11. J Clin Orthop Trauma. 2020 Oct;11(Suppl 5):S746-S751 - PubMed
  12. Clin Orthop Relat Res. 2011 Apr;469(4):994-1001 - PubMed
  13. J Bone Joint Surg Am. 2017 Mar 15;99(6):499-505 - PubMed
  14. Int Orthop. 2014 Feb;38(2):405-12 - PubMed
  15. Clin Orthop Relat Res. 2011 Apr;469(4):985-93 - PubMed
  16. Clin Orthop Relat Res. 2012 Oct;470(10):2730-6 - PubMed
  17. Knee Surg Sports Traumatol Arthrosc. 2016 Oct;24(10):3106-3114 - PubMed
  18. J Arthroplasty. 2003 Oct;18(7 Suppl 1):16-21 - PubMed
  19. JBJS Rev. 2020 Jan;8(1):e0059 - PubMed
  20. Acta Orthop Belg. 2005 Jun;71(3):315-20 - PubMed
  21. J Bone Joint Surg Am. 2007 Aug;89(8):1693-9 - PubMed
  22. BMC Musculoskelet Disord. 2019 Jun 3;20(1):272 - PubMed
  23. Clin Orthop Relat Res. 2011 Nov;469(11):3049-54 - PubMed
  24. BMJ. 2009 Jul 21;339:b2535 - PubMed
  25. Orthop Traumatol Surg Res. 2010 Dec;96(8):840-3 - PubMed
  26. J Bone Joint Surg Br. 2005 Mar;87(3):333-6 - PubMed
  27. Adv Orthop. 2014;2014:659047 - PubMed
  28. Knee. 2020 Mar;27(2):444-450 - PubMed

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