A systematic review of the evidence for single stage and two stage revision of infected knee replacement

BMC Musculoskeletal Disorders

Andrew P Sprowson²  Helen Parsons¹  Mike Reed⁴  Pedro Foguet³  Nicholas A Smith²  James PM Masters² 

[1] Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK;University of Warwick, Clinical Sciences Buildings, University Hospitals Coventry and Warwickshire, Coventry CV2 2DX, UK;Department of Trauma and Orthopaedics, University Hospitals Coventry and Warwickshire, Coventry CV2 2DX, UK;North Tyneside General Hospital, Rake Lane, North Shields, Tyne and Wear NE29 8NH, UK

关键词: Revision;    Arthroplasty;    Two-stage;    One stage;    Knee replacement;    Infection;   

Others  :  1130183
DOI  :  10.1186/1471-2474-14-222

 received in 2013-03-15, accepted in 2013-07-12,  发布年份 2013

【 摘 要 】

Background

Periprosthetic infection about the knee is a devastating complication that may affect between 1% and 5% of knee replacement. With over 79 000 knee replacements being implanted each year in the UK, periprosthetic infection (PJI) is set to become an important burden of disease and cost to the healthcare economy. One of the important controversies in treatment of PJI is whether a single stage revision operation is superior to a two-stage procedure. This study sought to systematically evaluate the published evidence to determine which technique had lowest reinfection rates.

Methods

A systematic review of the literature was undertaken using the MEDLINE and EMBASE databases with the aim to identify existing studies that present the outcomes of each surgical technique. Reinfection rate was the primary outcome measure. Studies of specific subsets of patients such as resistant organisms were excluded.

Results

63 studies were identified that met the inclusion criteria. The majority of which (58) were reports of two-stage revision. Reinfection rated varied between 0% and 41% in two-stage studies, and 0% and 11% in single stage studies. No clinical trials were identified and the majority of studies were observational studies.

Conclusions

Evidence for both one-stage and two-stage revision is largely of low quality. The evidence basis for two-stage revision is significantly larger, and further work into direct comparison between the two techniques should be undertaken as a priority.

【 授权许可】

   
2013 Masters et al.; licensee BioMed Central Ltd.