One-stage, instead of two-stage, surgery may be almost as safe for infected knee replacements

A one-stage knee replacement procedure to treat an infected prosthetic knee may offer similar outcomes for most people as the more commonly used two-stage procedure. Re-infection was seen in 7.6% of people after one-stage revision surgery, compared to 8.8% after a two-stage procedure. Other outcomes, such as range of motion, were also similar.

This review of observational studies described different techniques and approaches and because of the way this information was gathered there are some uncertainties as to whether these are now used or if other factors were important too.

From the NIHR Dissemination Centre

Nexgen found to be best value for total knee replacement

This economic analysis, using routinely collected National Joint Registry data from 2003 to 2012, found that Nexgen was the most cost-effective brand of prosthesis for total knee replacement. The cheapest brand was AGC Biomet, but Nexgen gave greater quality of life improvement, and the additional cost for the benefit - £2,300 per quality-adjusted life-year - was well within usual willingness to pay thresholds. Nexgen also had the lowest rates of revision surgery.

The study is the first to compare commonly-used prostheses for patient outcomes, costs and revision rates (how soon the replacement knee needed replacing). The comparisons relied on non-randomised, routinely collected data, and although the authors made every effort to correct for possible bias, the results should be treated cautiously. Prosthesis design improves over time, and so procurement decisions will need to be periodically re-examined.

From NIHR Dissemination Centre