Two-Stage Primary Arthroplasty in the Infected Native Knee: A Systematic Review and Pooled Analysis.

INTRODUCTION: The knee is the commonest native joint to develop an infection. A two-stage primary knee replacement, with an interim stage of debridement and cement spacer application, modelled after two-stage revision for periprosthetic joint infections (PJI) has been reported for the management of chronic infections. AIMS: To systematically review the literature to find the infection-free survival and outcomes of this operation and explore its indications. METHODS: PRISMA guidelines were followed for this review. A systematic search of 4 online databases was conducted on 9/8/2020. After reviewing 226 abstracts and applying our selection criteria, 10 papers were selected for full-text review, and 9 included in the final synthesis. RESULTS: On pooled analysis, an infection-free survival of 95.6% (CI 94.7-96.4) was found at 2 years in 139 knees, which was unchanged over the remainder of the follow-up (Mean 3.9 years). The complication rate after final implantation was 6% in those that did not develop reinfection. The mean pooled Knee Society Score (KSS) and KSS Function score among 70 patients (4 papers) was 83.4 (80.1-89.0) and 76.8 (71.5-78.0), respectively. The mean range of motion among 82 patients (6 papers) was more than 100°. CONCLUSIONS: Two-stage primary knee replacement is a safe, effective and reliable procedure with good results in the short to medium term. Further studies are required to lay down precise indications and cost-effectiveness of this procedure, in comparison to other strategies for chronic infection. All joint registries should develop methods to identify patients undergoing two-stage procedures, to understand their long-term survival and outcomes.

Roentgenographic and computerized tomography based morphometric analysis of cervical spinal canal diameters to establish normative measurements in an Indian population.

Compressive cervical myelopathy secondary to degenerative changes in the cervical spine is a common cause of neurologic morbidity in the elderly. Identification of canal stenosis and addressing it surgically in addition to the obvious compressive lesions is essential to obtain satisfactory results. We attempt to define the saggital and transverse diameters in a normal adult population presenting at our centre with head injuries. We found that the values were lower than those reported in comparable studies for a western population, and also that the dimensions in women are significantly lower than in men.