17 Key to the single-stage revision strategy is extensive debridement, identification of the infecting organisms and appropriate tailored antibiotic treatment. 16 An alternate one-stage strategy was developed by the Endo-Klinik and its use reported from 1976. However, patients require two distinct planned major surgeries and a period of several months with limited knee function and protracted distress, concern and uncertainty. 15 The period between operations allows targeted antibiotic treatment and monitoring of clinical status and inflammatory markers. The two-stage revision procedure was the first method reported for treatment of PJI of the knee that aimed to restore a functioning, painless knee. 14įor patients with acute PJI diagnosed before biofilm maturation occurs, DAIR with modular exchange is a reasonable treatment option but for the majority of patients outside of this window of opportunity, contemporary management involves surgical revision with extensive debridement and antibiotic treatment with either immediate implant replacement (single-stage) or delayed implant replacement (two-stage). 13 Delays to effective infection control inherent in this process may lead to a poor postreplacement outcome. 11 Rates of revision of implants following treatment with a DAIR may be lower with strict selection criteria, 12 but larger single-centre cohort studies suggest the rate remains around 20% by 2 years. However, about 45%–52% of patients receiving DAIR may subsequently need revision of their implants. Initial treatment may involve surgical debridement, antibiotics and implant retention (DAIR), particularly in early postoperative infections. 10 Patients with PJI after knee replacement and their treating surgeons face complex and protracted treatment pathways. 4 9īacteria adhere as biofilm to implants and periprosthetic tissues making the treatment of PJI difficult. 8 There is a paucity of evidence from UK centres and the available studies are old and based on single-centre data. 6 After aseptic revision and more complex knee replacement surgeries, infection rates may be considerably higher. 4–7 In a study from Finland, about 1.14% of patients had a PJI within 2 years of their primary knee replacement with a further 0.27% of patients presenting with PJI later than 2 years after primary surgery. 1–3Įstimates of the incidence of PJI after primary knee replacement have a range between 0.85% in Germany, 1.0% in the UK, 1.4% in Finland and 2.2% in the USA. Patients experience severe pain, functional difficulties, poor quality of life and, if untreated, loss of the affected limb or death. Deep prosthetic joint infection (PJI) is a rare but serious complication of total knee replacement.
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