Clinical Outcomes and Complications of 2-Stage Septic Versus Aseptic Revision Total Knee Arthroplasty: A Systematic Review and Meta-Analysis

Abstract

Background: Although several studies have compared the clinical outcomes of septic and aseptic revision total knee arthroplasty (TKA), their results have been controversial. Therefore, this study aimed to compare clinical outcomes and complications of septic and aseptic revision TKA through a systematic review and meta-analysis.

Methods: The PubMed (MEDLINE) and Embase databases were searched for studies evaluating the clinical outcomes and complications of 2-stage septic revision and aseptic revision TKAs. A systematic review of clinical outcomes (Knee Society Knee and Function Scores and range of motion) and complications (reoperation, infection, and failure rates) was conducted.

Results: Thirteen studies were included in the systematic review. The mean MINORS (Methodological Index for NOn-Randomized Studies) score of the included studies was 20.5 (range, 18 to 22). The meta-analysis revealed higher reoperation (risk ratio [RR], 1.98; 95% confidence interval [CI], 1.50 to 2.62; p < 0.00001), infection (RR, 4.08; 95% CI, 2.94 to 5.64; p < 0.00001), and failure rates (RR, 2.88; 95% CI, 1.38 to 6.03; p = 0.005) in septic revision TKAs than in aseptic revision TKAs. Moreover, septic revision TKAs showed lower Knee Society Knee Scores compared with aseptic TKAs (mean difference [MD], -6.86; 95% CI, -11.80 to -1.92; p = 0.006). However, the Knee Society Function Score (MD, -1.84; 95% CI, -7.84 to 3.80; p = 0.52) and range of motion (MD, -6.96°; 95% CI, -16.23° to 2.31°; p = 0.14) were not significantly different between septic and aseptic revision TKAs.

Conclusions: Despite the heterogeneity of prosthesis designs and surgical protocols used in septic and aseptic revision TKAs, the results of this systematic review suggest that 2-stage septic revision TKAs have poorer clinical outcomes and higher complication rates than aseptic revision TKAs do.

Level of evidence: Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.