1.5-Stage Exchange Arthroplasty for Total Knee Arthroplasty Periprosthetic Joint Infections.

Journal Article (Journal Article)

BACKGROUND: Periprosthetic joint infection (PJI) in total knee arthroplasty (TKA) is a challenging problem. The purpose of this study was to outline a novel technique to treat TKA PJI. We define 1.5-stage exchange arthroplasty as placing an articulating spacer with the intent to last for a prolonged time. METHODS: A retrospective review was performed from 2007 to 2019 to evaluate patients treated with 1.5-stage exchange arthroplasty for TKA PJI. Inclusion criteria included: articulating knee spacer(s) remaining in situ for 12 months and the patient deferring a second-stage reimplantation because the patient had acceptable function with the spacer (28 knees) or not being a surgical candidate (three knees). Thirty-one knees were included with a mean age of 63 years, mean BMI 34.4 kg/m2, 12 were female, with a mean clinical follow-up of 2.7 years. Cobalt-chrome femoral and polyethylene tibial components were used. We evaluated progression to second-stage reimplantation, reinfection, and radiographic outcomes. RESULTS: At a mean follow-up of 2.7 years, 25 initial spacers were in situ (81%). Five knees retained their spacer(s) for some time (mean 1.5 years) and then underwent a second-stage reimplantation; one of the five had progressive radiolucent lines but no evidence of component migration. Three knees (10%) had PJI reoccurrence. Four had progressive radiolucent lines, but there was no evidence of component migration in any knees. CONCLUSIONS: 1.5-stage exchange arthroplasty may be a reasonable method to treat TKA PJI. At a mean follow-up of 2.7 years, there was an acceptable rate of infection recurrence and implant durability.

Full Text

Duke Authors

Cited Authors

  • Hernandez, NM; Buchanan, MW; Seyler, TM; Wellman, SS; Seidelman, J; Jiranek, WA

Published Date

  • March 2021

Published In

Volume / Issue

  • 36 / 3

Start / End Page

  • 1114 - 1119

PubMed ID

  • 33162276

Electronic International Standard Serial Number (EISSN)

  • 1532-8406

Digital Object Identifier (DOI)

  • 10.1016/j.arth.2020.09.048


  • eng

Conference Location

  • United States