Midterm Survival of a Varus–Valgus Constrained Implant following One-Stage Revision for Periprosthetic Joint Infection: A Single-Center Study

Abstract

Revision total knee arthroplasty (TKA) is challenging to perform in patients with periprosthetic joint infection (PJI) due to the difficulty of eradicating the infection and potential for bone and ligamentous deficits. The current study aimed to evaluate the midterm survival of varus–valgus constrained (VVC) implants used in one-stage revision TKA for chronic PJI at our institution. This retrospective analysis included 132 patients with chronic PJI who underwent one-stage revision using a VVC implant. The average follow-up was 51.6 months (range: 24–85 months). Five-year survival analysis was performed to set recurrent infection and mechanical failure as the end point. Hospital for special surgery (HSS) as functional outcomes was evaluated preoperatively and at the latest follow-up. A total of 12 patients (9.1%) underwent retreatment for reinfection (nine patients) and mechanical failure (three patients). The overall 5-year revision-free survival was 82.7%, the infection-free survival was 91.1%, and the mechanical failure-free survival was 98.3%. The preoperative HSS knee score improved from 35.6 points (range: 24.3–47.7 points) preoperatively to 76.8 points (range: 57.2–87.6 points) at the latest follow-up. Complications were identified in 20 patients (15.2%) which included aseptic osteolysis in 4 cases, acceptable flexion instability in 3 cases, arthrofibrosis in 2 patients, hematomas in 2 cases, calf intermuscular venous thrombosis in 6 patients, and femoral stem tip pain in 3 cases. This is the first study to report the outcomes of one-stage revision using VVC implants for knee PJI. Improved functional outcomes and good midterm survival are demonstrated at an average follow-up of 51.6 months.

Keywords

varus–valgus constrained Implant - one-stage revision - total knee arthroplasty - periprosthetic joint infection

^* These authors contributed equally to the work described in the article and share first-author status.

Publikationsverlauf

Eingereicht: 18. Januar 2021

Angenommen: 31. Mai 2021

Artikel online veröffentlicht:
16. Juli 2021

• References

• 1 Kurtz SM, Lau E, Watson H, Schmier JK, Parvizi J. Economic burden of periprosthetic joint infection in the United States. J Arthroplasty 2012; 27 (08) 61-5.e1
• 2 Blom AW, Brown J, Taylor AH, Pattison G, Whitehouse S, Bannister GC. Infection after total knee arthroplasty. J Bone Joint Surg Br 2004; 86 (05) 688-691
• 3 Jämsen E, Huhtala H, Puolakka T, Moilanen T. Risk factors for infection after knee arthroplasty. A register-based analysis of 43,149 cases. J Bone Joint Surg Am 2009; 91 (01) 38-47
• 4 Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007; 89 (04) 780-785
• 5 Insall J, Tria AJ, Scott WN. The total condylar knee prosthesis: the first 5 years. Clin Orthop Relat Res 1979; (145) 68-77
• 6 Röhner E, Benad K, Zippelius T. et al. Good clinical and radiological results of total knee arthroplasty using varus valgus constrained or rotating hinge implants in ligamentous laxity. Knee Surg Sports Traumatol Arthrosc 2019; 27 (05) 1665-1670
• 7 Lee JK, Lee S, Kim D. et al. Revision total knee arthroplasty with varus-valgus constrained prosthesis versus posterior stabilized prosthesis. Knee Surg Sports Traumatol Arthrosc 2013; 21 (03) 620-628
• 8 Tibrewal S, Malagelada F, Jeyaseelan L, Posch F, Scott G. Single-stage revision for the infected total knee replacement: results from a single centre. Bone Joint J 2014; 96-B [phone]
• 9 Haddad FS, Sukeik M, Alazzawi S. Is single-stage revision according to a strict protocol effective in treatment of chronic knee arthroplasty infections?. Clin Orthop Relat Res 2015; 473 (01) 8-14
• 10 Marx RG. Knee rating scales. Arthroscopy 2003; 19 (10) 1103-1108
• 11 McPherson EJ, Woodson C, Holtom P, Roidis N, Shufelt C, Patzakis M. Periprosthetic total hip infection: outcomes using a staging system. Clin Orthop Relat Res 2002; (403) 8-15
• 12 Ji B, Wahafu T, Li G. et al. Single-stage treatment of chronically infected total hip arthroplasty with cementless reconstruction: results in 126 patients with broad inclusion criteria. Bone Joint J 2019; 101-B [phone]
• 13 Parvizi J, Zmistowski B, Berbari EF. et al. New definition for periprosthetic joint infection: from the Workgroup of the Musculoskeletal Infection Society. Clin Orthop Relat Res 2011; 469 (11) 2992-2994
• 14 Ji B, Li G, Zhang X, Wang Y, Mu W, Cao L. Effective treatment of single-stage revision using intra-articular antibiotic infusion for culture-negative prosthetic joint infection. Bone Joint J 2020; 102-B [phone]
• 15 Engh GA, Parks NL. The management of bone defects in revision total knee arthroplasty. Instr Course Lect 1997; 46: 227-236
• 16 Gofton WT, Tsigaras H, Butler RA, Patterson JJ, Barrack RL, Rorabeck CH. Revision total knee arthroplasty: fixation with modular stems. Clin Orthop Relat Res 2002; (404) 158-168
• 17 Ji B, Zhang X, Xu B, Guo W, Mu W, Cao L. Single-stage revision for chronic fungal periprosthetic joint infection: an average of 5 years of follow-up. J Arthroplasty 2017; 32 (08) 2523-2530
• 18 Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 1989; (248) 13-14
• 19 Haas SB, Insall JN, Montgomery III W, Windsor RE. Revision total knee arthroplasty with use of modular components with stems inserted without cement. J Bone Joint Surg Am 1995; 77 (11) 1700-1707
• 20 Costa GG, Lo Presti M, Agrò G. et al. Difficult primary total knee arthroplasty requiring a varus-valgus constrained implant is at higher risk of periprosthetic infection. Knee Surg Sports Traumatol Arthrosc 2020; 28 (12) 3787-3795
• 21 Reina N, Salib CG, Pagnano MW, Trousdale RT, Abdel MP, Berry DJ. Varus-valgus constrained implants with a mobile-bearing articulation: results of 367 revision total knee arthroplasties. J Arthroplasty 2020; 35 (04) 1060-1063
• 22 Wilke B, Wagner E, Trousdale R. Long-term survival of a semi-constrained implant following revision for infection. J Arthroplasty 2015; 30 (05) 808-812
• 23 Pangaud C, Ollivier M, Argenson JN. Outcome of single-stage versus two-stage exchange for revision knee arthroplasty for chronic periprosthetic infection. EFORT Open Rev 2019; 4 (08) 495-502
• 24 Jenny JY, Barbe B, Cazenave A, Roche O, Massin P. French Society for Hip and Knee Surgery (SFHG). Patient selection does not improve the success rate of infected TKA one stage exchange. Knee 2016; 23 (06) 1012-1015
• 25 Massin P, Delory T, Lhotellier L. et al. Infection recurrence factors in one- and two-stage total knee prosthesis exchanges. Knee Surg Sports Traumatol Arthrosc 2016; 24 (10) 3131-3139
• 26 Anderson JA, Baldini A, MacDonald JH, Tomek I, Pellicci PM, Sculco TP. Constrained condylar knee without stem extensions for difficult primary total knee arthroplasty. J Knee Surg 2007; 20 (03) 195-198
• 27 Siqueira MBP, Jacob P, McLaughlin J. et al. The varus-valgus constrained knee implant: survivorship and outcomes. J Knee Surg 2017; 30 (05) 484-492
• 28 Kim YH, Park JW, Kim JS, Oh HK. Long-term clinical outcomes and survivorship of revision total knee arthroplasty with use of a constrained condylar knee prosthesis. J Arthroplasty 2015; 30 (10) 1804-1809
• 29 Breugem SJ, van Ooij B, Haverkamp D, Sierevelt IN, van Dijk CN. No difference in anterior knee pain between a fixed and a mobile posterior stabilized total knee arthroplasty after 7.9 years. Knee Surg Sports Traumatol Arthrosc 2014; 22 (03) 509-516
• 30 Graves S, Sedrakyan A, Baste V. et al. International comparative evaluation of knee replacement with fixed or mobile-bearing posterior-stabilized prostheses. J Bone Joint Surg Am 2014; 96 (Suppl. 01) 59-64
• 31 Zeng YM, Yan MN, Li HW, Zhang J, Wang Y. Does mobile-bearing have better flexion and axial rotation than fixed-bearing in total knee arthroplasty? A randomised controlled study based on gait. J Orthop Translat 2019; 20: 86-93