Clinical Outcome After Infected Total Knee and Total Hip Arthroplasty

Abstract

Objective: Infection after total hip (THA) and knee arthroplasty (TKA) is a serious complication which typically leads to a long lasting and intensive surgical and medicamentous treatment. The aim of this study was to identify factors that influence outcome after revision surgery caused by prosthetic infection.Methods: We retrospectively analyzed 64 patients who had revision surgery between 1989 and 2009 due to periprosthetic infection. We examined a total of 69 joints (TKA: 36%, THA: 64%), follow-up 5.1 years (0.5-21 years) after the initial surgical intervention. The mean patient age at time of surgery was 67 years old (43-79 years old). Clinical data and scores including the Western Ontario and McMaster Universities (WOMAC)-Index, the Harris Hip Score (HHS) and the Hospital for Special Surgery Score (HSS) were surveyed. Results: There was no difference in clinical scores regarding treatment between a single and a multiple stage treatment regime. Infections with multiple microorganisms and Enterococcus spp. lead to a significantly higher number of interventions. Using a modified Tsukayama system we classified 24% as type I, 34% type II and 42% type III- infections, with no differences in clinical outcome. Overweight patients had a significantly lower HHS and WOMAC-score. Immunosuppression leads to a worse WOMAC and HSS-Score. An increased number of procedures was associated to a limping gait. Conclusion: Thorough surgical technique leads to good clinical results independent of infection-type and treatment philosophy. Level of Evidence III, Case Control Study.

Factors Associated with Choice and Success of One- Versus Two-Stage Revision Arthroplasty for Infected Hip and Knee Prostheses

“…and Peptostreptococcus spp. were associated with treatment failure, which is similar to prior studies [12]. Unlike previous studies, we did not detect a statistically significantly higher rate of treatment failure with S. aureus [10].…”

Bacterial Extracellular DNA Production Is Associated with Outcome of Prosthetic Joint Infections

“…Mittag et al examined clinical outcomes after infected knee and hip arthroplasty using clinical data of 64 patients and scores including the Western Ontario and McMaster Universities- (WOMAC-) Index, the Harris Hip Score (HHS) and the Hospital for Special Surgery Score (HSS). They did not demonstrate a correlation between implant infection classified according to the modified Tsukayama classification system [ 22 ] and outcome defined using WOMAC, HSS or HHS score [ 23 ]. However, in this study, the most frequent pathogens were Enterococcus spp .…”

Outcome of Revision Surgery for Infection After Total Knee Arthroplasty

“…The cumulative rates of PJI at 1 year after primary knee arthroplasty range from 0.5% to 5% depending on the patient's risk factors [2][3][4][5] . Although PJI rates following arthroplasty are low, the number of revision arthroplasties due to PJI is rising because of an increasing number of primary knee arthroplasty patients 6 . PJI is the leading cause of revision surgery, accounting for .15% of all revisions 7,8 , and PJI is the dominant cause of revision during the first 4 years after primary surgery 9 .…”