Negative impact of prior debridement on functional outcome of subsequent two-stage revision for early knee periprosthetic infection
Bibliographic record
Abstract
PURPOSE: To compare the functional outcome of two-stage revision (2SR) in patients without a prior debridement, antibiotics and implant retention with those patients who underwent 2SR after a failed debridement, antibiotics and implant retention for early periprosthetic joint infection following total knee arthroplasty (TKA). Negative impact of prior failed debridement, antibiotics and implant retention on the functional outcome of subsequent 2SR was hypothesized. METHODS: Case-control study of 49 patients initially treated with 2SR (group A) and 43 treated with 2SR after a prior failed debridement, antibiotics and implant retention (group B). Functional outcome was assessed by the Knee Society Scores (KSS) and Western Ontario and McMaster Universities (WOMAC) questionnaire. Range of motion (ROM) of the knee was also measured. RESULTS: The median follow-up was 4.1 (range 3-7) years. At final follow-up, KSS-knee (p = 0.001), KSS-function (p = 0.002), WOMAC-function (p = 0.022) and ROM (p = 0.002) were significantly better in the group A as compared to the group B. There was no significant difference between groups in the WOMAC-pain score (p = 0.597). In multivariate analysis, BMI < 30 (OR 3.1, 95% CI 1.7-4.9, p = 0.026), non- Staphylococcus causative microorganism (OR 2.7, 95% CI 1.6-5.9, p = 0.037), and 2SR procedure (OR 2.4, 95% CI 1.7-5.2, p = 0.018) were significant predictors of successful functional outcome. CONCLUSIONS: A prior debridement, antibiotics and implant retention has been shown to have a negative impact on the functional outcome of a subsequent 2SR. These findings suggest that treatment with debridement, antibiotics and implant retention for early periprosthetic infection should only be used in selected patients, and the first option in those patients with Staphylococcus organisms should be 2SR. LEVEL OF EVIDENCE: IV.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".