Factors Associated With 20-Year Cumulative Risk of Infection After Aseptic Index Revision Total Knee Arthroplasty

Nikolaus, O. Brant; McLendon, Paul B.; Hanssen, Arlen D.; Mabry, Tad M.; Berbari, Elie F.; Sierra, Rafael J.

doi:10.1016/j.arth.2015.10.025

Cited by 27 publications

(14 citation statements)

References 22 publications

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“…Truncating the follow-up data at 2 years would have increased the number of patients, but at the cost of missing relevant changes in KSS. In addition, a longer follow-up gives patients more relevant expectations regarding the clinical process [23]. Before integrating this prediction rule in daily practice, the prediction rule needs to be externally validated, and important determinants such as BMI, smoking and diabetes mellitus should be taken into consideration as well.…”

Section: Discussionmentioning

confidence: 99%

“…A number of patient-related factors have been identified that play an important role in predicting rTKA outcome, such as age, race, body mass index, and diabetic status [9, 10, 22, 23, 26]. In addition, severe stiffness (formerly referred to as arthrofibrosis) as main reason for revision resulted in a worse outcome compared to other reasons for revision like instability, infection and malposition [33].…”

Section: Introductionmentioning

confidence: 99%

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Age, gender, functional KSS, reason for revision and type of bone defect predict functional outcome 5 years after revision total knee arthroplasty: a multivariable prediction model

Verbeek

Hannink

Defoort

et al. 2019

Knee Surg Sports Traumatol Arthrosc

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Purpose The number of revision total knee arthroplasties (rTKA) is increasing. Unfortunately, not all patients benefit from revision surgery. The aim of this study was to develop a clinical prediction model that can be used to predict the functional outcome 5 years after rTKA. Methods Data of patients receiving rTKA at Sint Maartenskliniek, Nijmegen, The Netherlands, from 2004 onwards were prospectively collected. Demographic and clinical variables and patient-reported outcome scores were collected and considered as potential predictors. Beneficial outcome was defined as an increase of ≥ 20 points on the functional knee society scores (fKSS) or an absolute fKSS ≥ 80 points 5 years after surgery. The prediction model was developed using backward logistic regression. Regression coefficients were converted into an easy to use prediction rule. Results Overall, 295 rTKA patients were included of whom 157 (53%) had beneficial fKSS 5 years later. Age, gender, femoral bone defects, preoperative fKSS, and stiffness as reason for revision were included in the model. Men had a higher chance of beneficial fKSS than women (OR 1.59, 95% CI 0.91–2.78). Patients with major bone defects (OR 0.44, 95% CI 0.22–0.85), higher age (IQR OR 0.39, 95% CI 0.26–0.58), higher preoperative fKSS (IQR OR 0.42, 95% CI 0.30–0.59), and severe stiffness (OR 0.48, 95% CI 0.20–1.15) had a lower chance of successful outcome. The model’s AUC was 0.76, 95% CI 0.70–0.81. Conclusion Easily determinable characteristics of patients who need rTKA can be used to predict future functional outcome. Young men with low preoperative fKSS without severe stiffness are more likely to achieve a beneficial outcome. Level of evidence IV.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Age, gender, functional KSS, reason for revision and type of bone defect predict functional outcome 5 years after revision total knee arthroplasty: a multivariable prediction model

Verbeek

Hannink

Defoort

et al. 2019

Knee Surg Sports Traumatol Arthrosc

View full text Add to dashboard Cite

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“…Is there harm in treating all potential crystalline arthropathies after TKA as if they were infected? Potential risks of unnecessary operative intervention include increased cost [39], exposure to anesthetic, particularly if comorbidities are present [40], the psychosocial burden to the patient [41], and the risk of introducing infection into an aseptic knee, as revision surgery has been shown to carry increased infection risk [42,43]. On the contrary, delaying operative debridement of PJI may result in a missed window of opportunity for retention of nonmodular components, resulting in a more invasive 1-or 2-stage exchange.…”

Section: Discussionmentioning

confidence: 99%

Gout After Total Knee Arthroplasty

et al. 2020

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Crystalline arthropathies are well-known pathologies in a native knee; however, the literature is scarce with regards to crystalline arthropathies in a total knee arthroplasty (TKA). The presentation of crystalline arthropathy in a TKA can be similar to a periprosthetic joint infection (PJI), making it difficult to distinguish between the 2 diagnoses. We present 1 case highlighting the similarity between crystalline arthropathy and PJI. A 71-year-old man with a history of bilateral TKAs presented with bilateral painful knee effusions and was initially presumed to have PJIs; however, he was later diagnosed with gout and successfully treated medically. A complete review of the literature demonstrates that crystalline arthropathies after TKA are infrequently reported and can be difficult to decipher from PJIs, and there is a lack of standardized treatment.

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“…Initial baseline infection rates following revision TKA were obtained from the literature, ranging between 5 and 21% depending on the indication for revision. 5,7 We chose to use an infection rate of 9.0%, 5 as this infection rate represents the published overall deep infection rate following revision TKA and is within previously reported ranges. Furthermore, this infection rate is on the lower end of the spectrum and a low initial infection rate requires the proposed infection prevention strategy to have a greater relative impact to remain costeffective.…”

Section: Methodsmentioning

confidence: 99%

The Cost-Effectiveness of Closed Incisional Negative Pressure Wound Therapy for Infection Prevention after Revision Total Knee Arthroplasty

et al. 2021

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Recent investigations have shown that closed incisional negative pressure wound therapy (ciNPWT) decreases the rate of postoperative wound complications following revision total knee arthroplasty (TKA). In this study, we used a break-even analysis to determine whether ciNPWT is a cost-effective measure for reducing prosthetic joint infection (PJI) after revision TKA. The cost of ciNPWT, cost of treatment for PJI, and baseline infection rates following revision TKA were collected from institutional data and the literature. The absolute risk reduction (ARR) in infection rate necessary for cost-effectiveness was calculated using break-even analysis. Using our institutional cost of ciNPWT ($600), this intervention would be cost-effective if the initial infection rate of revision TKA (9.0%) has an ARR of 0.92%. The ARR needed for cost-effectiveness remained constant across a wide range of initial infection rates and declined as treatment costs increased. The use of ciNPWT for infection prevention following revision TKA is cost-effective at both high and low initial infection rates, across a broad range of treatment costs, and at inflated product expenses.

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Factors Associated With 20-Year Cumulative Risk of Infection After Aseptic Index Revision Total Knee Arthroplasty

Cited by 27 publications

References 22 publications

Age, gender, functional KSS, reason for revision and type of bone defect predict functional outcome 5 years after revision total knee arthroplasty: a multivariable prediction model

Age, gender, functional KSS, reason for revision and type of bone defect predict functional outcome 5 years after revision total knee arthroplasty: a multivariable prediction model

Gout After Total Knee Arthroplasty

The Cost-Effectiveness of Closed Incisional Negative Pressure Wound Therapy for Infection Prevention after Revision Total Knee Arthroplasty

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