Primary and revision knee arthroplasty: clinical analysis of treatment outcomes

In a retrospective study, the clinical data of 25 patients with verified periprosthetic infection of the knee joint who underwent two-stage revision arthroplasty in the Department of Orthopedics and Traumatology for Adults of the Institute of Traumatology and Orthopedics of the NAMS of Ukraine during 2014–2025 were analyzed. In 88% of cases, the primary indication for total arthroplasty was gonarthrosis. Subacute form of periprosthetic infection (3–24 months after total knee arthroplasty) was recorded in 56% of patients, late (>24 months, up to 12 years) — in 44%. Systemic risk factors (hypertension, diabetes mellitus, obesity, ischemic heart disease) were detected in 56% of patients. Microbiological examination confirmed the pathogen in 68% of cases; among them S. aureus was 88%. The median spacer interval was 4 months (range 2–8 months); 84% of patients underwent reimplantation within the optimal time frame of 3–6 months. Hinged structures were used for reimplantation in 60% of cases. Successful eradication of infection was achieved in 84% of patients. The results obtained confirm the effectiveness of the two-stage protocol and emphasize the importance of early diagnosis and preoperative optimization of the comorbid background.

References

1. Ouyang Y., Dai M. (2025) Global, regional, and national burden of knee osteoarthritis: findings from the Global Burden of Disease study 2021 and projections to 2045. J. Orthop. Surg. Res., 20(1): 766. doi: 10.1186/s13018-025-06140-0.
2. Chen J., Chen X., Wang T. et al. (2025) Global burden of knee osteoarthritis from 1990 to 2021: Trends, inequalities, and projections to 2035. PLoS One, 20(6): e0320115. doi: 10.1371/journal.pone.0320115.
3. Aabedi A., Fraix M.P., Agrawal D.K. (2025) Surgical interventions in Severe Osteoarthritis: Pros and Cons. J. Orthop. Sports Med., 7(1): 169–178. doi: 10.26502/josm.511500192.
4. Alrayes M.M., Sukeik M. (2023) Two-stage revision in periprosthetic knee joint infections. World J. Orthop., 14(3): 113–122.
5. Zhao Y., Fan S., Wang Z. et al. (2024) Systematic review and meta-analysis of single-stage vs two-stage revision for periprosthetic joint infection. BMC Musculoskelet. Disord., 25(1): 504.
6. Cizmic Z., Feng J.E., Huang R. et al. (2019) Hip and Knee Section, Prevention, Host Related: Proceedings of International Consensus on Orthopedic Infections. J. Arthroplasty, 34(2S): S255–S270. doi: 10.1016/j.arth.2018.09.010.
7. Eka A., Chen A.F. (2015) Patient-related medical risk factors for periprosthetic joint infection of the hip and knee. Ann. Transl. Med., 3(16): 233. doi: 10.3978/j.issn.2305-5839.2015.09.26.
8. Qiao Y., Li F., Zhang L. et al. (2023) A systematic review and meta-analysis comparing outcomes following total knee arthroplasty for rheumatoid arthritis versus for osteoarthritis. BMC Musculoskelet. Disord., 24(1): 484.
9. Parvizi J., Tan T.L., Goswami K. et al. (2018) The 2018 definition of periprosthetic hip and knee infection: an evidence-based and validated criteria. J. Arthroplasty, 33(5): 1309–1314.e2.
10. Yilmaz M.K., Abbaszadeh A., Tarabichi S. et al. (2023) Diagnosis of Periprosthetic Joint Infection: The Utility of Biomarkers in 2023. Antibiotics (Basel), 12(6): 1054. doi: 10.3390/antibiotics12061054.
11. Al-Jabri T., Ridha M., Wood M.J. et al. (2024) An overview of the current diagnostic approach to periprosthetic joint infections. Orthop. Rev. (Pavia), 17: 120308.
12. Sigmund I.K., Luger M., Windhager R. et al. (2022) Diagnosing periprosthetic joint infections: a comparison of infection definitions: EBJIS 2021, ICM 2018, and IDSA 2013. Bone Joint Res., 11(9): 608–618. doi: 10.1302/2046-3758.119.BJR-2022-0078.R1.
13. de Buys M., Moodley K., Cakic J.N. et al. (2023) Staphylococcus aureus colonization and periprosthetic joint infection in patients undergoing elective total joint arthroplasty: a narrative review. EFORT Open Rev., 8(9): 680–689. doi: 10.1530/EOR-23-0031.
14. Pangaud C., Ollivier M., Argenson J.N. (2019) Outcome of single-stage versus two-stage exchange for revision knee arthroplasty for chronic periprosthetic infection. EFORT Open Rev., 4(8): 495–502.
15. Lazic I., Scheele C., Pohlig F. et al. (2021) Treatment options in PJI — is two-stage still gold standard? J. Orthop., 23: 180–184. doi: 10.1016/j.jor.2020.12.021.
16. Mercurio M., Cofano E., Colace S. et al. (2024) Outcomes, Complications, and Eradication Rates of Two-Stage Revision Surgery for Periprosthetic Shoulder, Elbow, Hip, and Knee Infections: A Systematic Review. Prosthesis, 6: 1240–1258. doi: 10.3390/prosthesis6050089.
17. Harrabi H., Mamona-Kilu C., Meyer E. et al. (2025) Treatment Duration in Bacterial Prosthetic Joint Infections: A Narrative Review of Current Evidence. Antibiotics, 14: 1066. doi: 10.3390/antibiotics14111066.
18. Ahmad M.A., Ab Rahman S., Islam M.A. (2022) Prevalence and Risk of Infection in Patients with Diabetes following Primary Total Knee Arthroplasty: A Global Systematic Review and Meta-Analysis of 120,754 Knees. J. Clin. Med., 11(13): 3752. doi: 10.3390/jcm11133752.
19. Lin Y.C., Lin Y.H., Chou J.H. et al. (2022) Higher reinfection rate after two-stage revision arthroplasty in patients with refractory diabetes mellitus: a retrospective analysis with a minimum ten-year follow up. BMC Musculoskelet. Disord., 23: 990. doi: 10.1186/s12891-022-05964-9.
20. Farid Y.R., Thakral R., Finn H.A. (2015) Intermediate-Term Results of 142 Single-Design, Rotating-Hinge Implants: Frequent Complications May Not Preclude Salvage of Severely Affected Knees. J. Arthroplasty, 30(12): 2173–2180. doi: 10.1016/j.arth.2015.06.033.