Surgical Technique, Bone Loss, and Muscle Insufficiency

In recent years, it has been shown that the outcomes of one-stage septic prosthesis revisions of the knee joint are comparable in terms of freedom from infection and even slightly better in terms of clinical outcomes than two-stage revisions. In a literature review of 14 articles with one-stage septic knee prosthesis revision in 687 patients, found an average infection-free rate of 87.1% compared with 84.8% in 1086 patients in 18 articles with two-stage septic knee prosthesis revision. The mean Knee Society score tended to be slightly better at 80.0 points for one-stage revision compared with 77.8 points for two-stage revision. An analysis of the National Joint Register for England and Wales observed a lower re-revision rate after one-stage revision than after two-stage knee prosthesis revision (1.2 vs. 2.2, p <0.001). Mortality 6 and 18 months after surgery was significantly lower after one-stage prosthesis revision than after two-stage revision (hazard ratio at 6 months 0.51, p = 0.0049; hazard ratio at 18 months 0.33, p = 0.048). Thus, it is clear that this concept is becoming more widely adopted for a certain cohort of patients. Due to new developments of cones for meta-diaphysial fixation even periprosthetic joint infections with more severe bone defects (AORI II) can be treated with one-stage revision arthroplasty with predictable good results. As a prerequisite the microorganism should be identified before revision so that local and systemic specific antibiotic therapy can be chosen.