Higher failure rate of two-stage revision for infected knee arthroplasties in significantly compromised (host-C) patients.

PURPOSE: To evaluate clinical outcomes of two-stage revision arthroplasty for managing infected knee arthroplasties in significantly compromised patients (host-C). METHODS: This was a prospective consecutive series of two-stage revisions of infected total knee arthroplasties in host-C-type patients with a minimum 2-year follow-up using objective and patient-reported outcome measures. Thirteen consecutive patients were included and prospectively followed with a median 5-year follow-up (range 2-10). Median age was 68 years (range 59-73) at time of initial presentation. All patients were type-C host using McPherson classification system. All patients had primary arthroplasties in situ with confirmed chronic infections; the infecting pathogens were Staphylococcus aureus in 5/13 patients, coagulase-negative Staphylococci in 5/13, and the remaining three patients had mixed growth. All patients underwent two-stage revision protocol. RESULTS: At the final follow-up, 9/13 patients were infection free achieving satisfactory outcomes. Two patients had recurrent infections with different organisms and treated with suppressive antibiotics and salvage knee arthrodesis, respectively. Furthermore, two patients had chronic pain and poor functional outcomes with deficient extensor mechanism and significant bone loss; later underwent salvage knee arthrodesis. The preoperative knee society score (median 35.5; range 22-51; n = 10) showed a statistically significant improvement at the final follow-up (median 79.5; range 49-87; n = 10) p < 0.05. Patients reported outcome scores at the final follow-up were WOMAC-knee (median 59.1; range 47.7-94.7; n = 13) and Oxford knee score (median 26; range 11 to 43; n = 13). CONCLUSION: This study highlights the challenge of treating infected knee arthroplasties in physiologically compromised patients with 9/13 (69%) having satisfactory clinical outcomes. LEVEL OF EVIDENCE: Case series, level IV.

Two-stage revisions of infected hip replacements: Subspecialisation and patient-reported outcome measures.

BACKGROUND: Two-stage revision arthroplasty remains the gold standard for managing infected hip replacements. Subspecialisation, high-volume hospitals and surgeons have been linked to improved clinical outcomes. The aim of this study was to assess clinical outcomes of 2-stage revision infected hip replacements of a subspecialist surgeon. METHODS: Consecutive single surgeon series of 2-stage revisions of infected total hip replacements in a district genearl hospital settings with minimum 2 years follow up using clinical and patient-reported outcome measures. RESULTS: Twenty-nine consecutive patients were included with average follow up of 5 years (range 2-9 yrs). Average age was 63 yrs (range 30-75), osteoarthritis was the underlying diagnosis in 65%, 31% had previous hip surgeries prior to index hip replacements. Two-thirds presented with chronic infections, staph aureus was isolated in 55%. Infection eradication rate at final follow up was 96.5% (1 reinfection). Overall complication rate was 13.8% (1 dislocation, 1 reinfection, 2 post-op wound haematoma requiring wash-outs). Mean patients reported outcome measures at final follow up were WOMAC hip score 76.3 (SD 13.6) (range 39.1-94.5); Oxford hip score 35.4 (SD 7.7) (range 17-45); and Hip disability & osteoarthritis outcome score (HOOS) 76 (SD 12.5) (range 41.9-92.5) suggesting satisfactory patient-reported outcomes. CONCLUSIONS: Our study demonstrates successful clinical outcomes and high infection-eradication rate achieved within district general hospital settings. Our experience suggests that comparable outcomes to tertiary centres in managing periprosthetic joint infections can be achieved in district general hospital settings through a local pathway of subspecialty trained arthroplasty surgeons within a local multidisciplinary MDT approach and adequate microbiology support.

Failure of Cemented Constrained Acetabular Component at the Bipolar Outer Femoral Head Interface in Revision Hip Arthroplasty.

Constrained acetabular components are used as a salvage option for unstable total hip arthroplasties particularly in elderly low demand patients. Their indications include multiple failed revisions with abductor deficiency, neurologic or neuromuscular impairment, recurrent dislocations where the cause of instability cannot be identified despite well-aligned components. Failure of these components occurred due to increased forces across the bone-component interface or failure of the locking mechanisms. We report a unique mode of failure of a constrained cup through dissociation of the outer femoral bipolar femoral head interface in all-poly cemented constrained components 5-years post implantation with a review of the relevant literature.

Infected total hip replacements: assessment and management.

Infected total hip replacements pose a diagnostic and management challenge. Careful history, clinical examination, blood tests, plain radiographs and hip aspiration are all part of the clinical assessment. International consensus on establishing the diagnosis helps surgeons to formulate management plans. Management strategies include debridement and prosthesis retention, single-stage revision, two-stage revision, suppressive antibiotic treatment and excision arthroplasty. This article reviews the clinical assessment, diagnosis, principles of surgical management and outcomes of revision surgery of infected total hip replacements.

Outcomes of Implant-Arthrodesis as Limb Salvage for Failed Total Knee Arthroplasties with Significant Bone Loss: Case Series.

PURPOSE: We sought to evaluate our consecutive series of knee-implant arthrodesis patients for failed total knee arthroplasties with medium term clinical and radiographic outcomes. METHODS: We conducted a retrospective review of a consecutive series of 4 patients (average age, 75 years; range, 69-79) with failed knee arthroplasties and deficient extensor mechanism who underwent implant arthrodesis with a minimum 2-year follow-up. The primary outcome measure was the patient's reported outcome measures (Short-Form 12) and visual analogue scale for knee pain at final follow-up. RESULTS: All patients had multiple medical comorbidities, multiple previous knee surgeries with failed nonfunctional knee arthroplasties. Three patients had chronic infections and one had chronic pain and instability, and all had deficient extensor mechanism. Average follow-up was 5.5 years (range, 2-8), and the primary goal of surgery was achieved in all four patients. The average VAS score for knee pain was 3 of 10, and SF-12 was 36.16 (physical score) and 55.70 (mental score), indicating satisfactory outcomes. CONCLUSION: Satisfactory clinical and patient-reported outcomes can be achieved with implant arthrodesis as limb salvage for failed total knee arthroplasties with significant bone loss at medium-term follow-up.

Assessment and management of infected total knee replacements.

Infection following total knee replacement surgery is a challenging and devastating complication. Clinical assessment including history, examination, radiographs, blood tests and knee aspirations helps to establish the diagnosis. Revision surgery is typically required to eradicate infection and restore function. This has traditionally been performed through two-stage revision surgery, although single-stage revision surgery is gaining popularity with comparable results in carefully selected patients. This article reviews the clinical assessment and principles of surgical management of infected total knee replacements.

Custom-Made Cement-Linked Distal Femoral Replacement for Interprosthetic Femur Fractures: Five-Year Follow-Up.

Interprosthetic femur fractures between total hip and total knee replacements are challenging injuries with rising incidence. Stability of the either implants, quality, and quantity of remaining bone as well as patients' comorbidities play an important role in operative management. Open reduction and internal fixation, advanced revision arthroplasty techniques, and megaprostheses are available options. In more complex cases, custom-made implants maybe necessary to achieve immediate weight-bearing and restore function.