The Journal of Arthroplasty , Volume 34 , Issue 2 , 369 - 374

The Effectiveness of Repeat Two-Stage Revision for the Treatment of Recalcitrant Total Knee Arthroplasty Infection

Vadiee, Iman et al.


The gold-standard method in North America for the management of infected total knee arthroplasty is 2-stage revision arthroplasty. This has provided generally a high success rate. However, persistent infection after 2-stage revision knee arthroplasty does occur. The purpose of this study was to predict the success rate of second, 2-stage revision arthroplasty.


All infected total knee arthroplasty treated between 2000 and 2015 that were operated by a single senior surgeon were reviewed retrospectively. Patients were stratified according to general health and limb status according to the Musculoskeletal Infection Society (MSIS) scoring system. The reinfection rate at the last follow-up was identified. The chi-square test and Fisher exact test were used to compare binary variables.


We found a statistical relationship between the higher stage of MSIS score, type of microorganism, flap surgery, and reinfection rate after reimplantation of second two-stage surgery. There is not any statistically significant correlation between age, gender, constraint pattern of prosthesis, number of spacers, and time interval between the first and second stages of second 2-stage surgery with the numbers available in this study.


Another 2-stage knee revision is an effective method of treatment. However, we found a higher incidence of failure in those patients with poor general health based on the MSIS score, inadequate soft tissue envelope and resistant bacteria. The success of second, 2-stage protocol is best in patients with optimized general health, soft tissue coverage, and antibiotic-sensitive microorganism. Patients who cannot be optimized are most likely to require amputation or knee arthrodesis than another futile 2-stage surgery.

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