Masters, James P. M., Smith, Nicholas A., Foguet, Pedro, Reed, Mike R., Parsons, Helen and Sprowson, Andrew P. (2013) A systematic review of the evidence for single stage and two stage revision of infected knee replacement. BMC Musculoskeletal Disorders, Volume 14 (Number 1). p. 222. doi:10.1186/1471-2474-14-222 ISSN 1471-2474.

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Abstract

BACKGROUND:
Periprosthetic infection about the knee is a devastating complication that may affect between 1% and 5% of knee replacement. With over 79 000 knee replacements being implanted each year in the UK, periprosthetic infection (PJI) is set to become an important burden of disease and cost to the healthcare economy. One of the important controversies in treatment of PJI is whether a single stage revision operation is superior to a two-stage procedure. This study sought to systematically evaluate the published evidence to determine which technique had lowest reinfection rates.
METHODS:
A systematic review of the literature was undertaken using the MEDLINE and EMBASE databases with the aim to identify existing studies that present the outcomes of each surgical technique. Reinfection rate was the primary outcome measure. Studies of specific subsets of patients such as resistant organisms were excluded.
RESULTS:
63 studies were identified that met the inclusion criteria. The majority of which (58) were reports of two-stage revision. Reinfection rated varied between 0% and 41% in two-stage studies, and 0% and 11% in single stage studies. No clinical trials were identified and the majority of studies were observational studies.
CONCLUSIONS:
Evidence for both one-stage and two-stage revision is largely of low quality. The evidence basis for two-stage revision is significantly larger, and further work into direct comparison between the two techniques should be undertaken as a priority.

Item Type:	Journal Article
Subjects:	R Medicine > R Medicine (General) Z Bibliography. Library Science. Information Resources > ZA Information resources
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Arthroplasty, Knee -- Surgery, Infection, Systematic reviews (Medical research), Evidence-based medicine
Journal or Publication Title:	BMC Musculoskeletal Disorders
Publisher:	Biomed central
ISSN:	1471-2474
Official Date:	29 July 2013
Dates:	Date Event 29 July 2013 Published
Volume:	Volume 14
Number:	Number 1
Page Range:	p. 222
DOI:	10.1186/1471-2474-14-222
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access (Creative Commons)
Date of first compliant deposit:	25 December 2015
Date of first compliant Open Access:	25 December 2015

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