Comparison of Difference in Hematologic and Hemodynamic Outcomes between Primary Total Knee Arthroplasty and Revision of Infected Total Knee Arthroplasty

Abstract

PurposeThis study is to identify preoperative cautions for revision of infected total knee arthroplasty (TKA) by understanding the differences in hematologic and hemodynamic changes between primary TKA and revision of infected TKA.Materials and MethodsThe study included 40 patients in each of the two groups: one group with patients who underwent TKA and the other group with patients who underwent revision of infected TKA. All patients matched for age and body mass index. The following data were compared between the groups: changes in blood pressure, variations in hemoglobin level, amount of postoperative blood loss and transfused blood, incidence of blood transfusion, white blood cell (WBC) count, albumin level, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and liver enzyme level.ResultsThe hemoglobin levels, transfusion rate, and the amount of blood loss were significantly higher in the revision group (p=0.012). In both groups, CRP reached the highest level on the 3rd postoperative day but it was normalized 2 weeks postoperatively; however, the revision TKA group showed a greater tendency to normalization (p=0.029). There were significant differences between the groups in ESR, WBC, blood pressure, and changes in liver enzyme levels.ConclusionsRevision of infected TKA results in greater hemodynamic variations than primary TKA. Therefore, more efforts should be made to identify pre- and postoperative hemodynamic changes and hematologic status.

Risk Adjustment Is Necessary in Value-based Outcomes Models for Infected TKA

“…When analyzing differences in specific complications, patients with infected TKAs undergoing revision had higher risks of sepsis, wound infection, shock, and renal failure than patients undergoing revision TKA in the absence of infection. These results could be explained by prior studies that have shown that infected patients undergoing revision TKA have greater hemodynamic variation and blood loss than aseptic patients [28]. Other studies have linked PJI to higher rates of DVT in patients undergoing revision arthroplasty [10], but we found no increase when controlling for other confounding variables.…”

The Association of International Normalized Ratio with Postoperative Complications in Revision Total Knee Arthroplasty

“…Several studies have examined the increased postoperative bleeding risk in revision total joint arthroplasty when compared with primary total joint arthroplasty. [19][20][21][22] The increased soft tissue and bone resection necessitated in revision joint surgery elevate the risk for postoperative complications and bleeding, making blood conservation strategies and preoperative patient optimiza-tion important. 19,20 Similarly, with rates of rTKA projected to increase 601% from 2005 to 2030 within the United States, patient selection and understanding of perioperative risk are of increasing importance.…”

Treatment of Infected Total Knee Arthroplasty

“…Also, blood transfusion rates are higher after revision of infected TKA, which often leads to increased postoperative complications 13 – 15) . Shon et al 4) article in this issue reports that the transfusion rate was higher in the revision TKA group (20%) than in the primary TKA group (12%), and the postoperative blood loss and transfusion volume were also greater in the revision group. The authors emphasize that surgeons should pay more attention to patients’ postoperative general condition to reduce postoperative complications.…”

“…Another original article by Juul et al 3) reported on the use of a new knee prosthesis as an articulating spacer in two-stage revision of infected TKA. The other original article by Shon et al 4) compared hemodynamic and hematologic changes between the TKA group and the revision group.…”