Factors influencing the outcome of deep infection following total knee arthroplasty

Nakano, Nobuaki; Matsumoto, Tomoyuki; Ishida, Kazunari; Tsumura, Nobuhiro; Muratsu, Hirotsugu; Hiranaka, Takafumi; Kuroda, Ryosuke; Kurosaka, Masahiro

doi:10.1016/j.knee.2015.04.005

Cited by 9 publications

(4 citation statements)

References 32 publications

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“…Many of these factors are patient and perioperative related. [3][4][5][6][7][8] However, there remain numerous potentially modifiable risk factors such as the anesthesia technique (eg, neuraxial vs general anesthesia) that may reduce rates of both infectious and noninfectious complications. [9][10][11] The role of neuraxial anesthesia in reducing the SSI after KA or HA is uncertain.…”

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confidence: 99%

The Impact of Neuraxial Versus General Anesthesia on the Incidence of Postoperative Surgical Site Infections Following Knee or Hip Arthroplasty

Zorrilla-Vaca

Grant

Mathur

et al. 2016

Regional Anesthesia and Pain Medicine

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confidence: 99%

The Impact of Neuraxial Versus General Anesthesia on the Incidence of Postoperative Surgical Site Infections Following Knee or Hip Arthroplasty

Zorrilla-Vaca

Grant

Mathur

et al. 2016

Regional Anesthesia and Pain Medicine

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“…Alongside the pathogen identified, risk factors for persistent infection and further revision surgery include patient factors such as age and immune competence, as well as surgical factors such as the type of revision strategy adopted and the time between primary TKA and the diagnosis of PJI. 29 Younger age has been shown in the past to be associated with increased risk of PJI. In large retrospective analyses, the risk of PJI was 1.8 times higher in patients younger than 50 years of age.…”

Section: Discussionmentioning

confidence: 99%

The Microbiology of Knee Prosthetic Joint Infection and its Influence on Persistent Infection

Putnis,

Klasan,

Bott

et al. 2024

J Knee Surg

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Introduction Periprosthetic joint infection (PJI) following total knee arthroplasty (TKA) is a severe complication causing a significant burden. The study aims were to establish the epidemiology of microorganisms in TKA PJI, the rate of persistent infection requiring further surgery, and the risk factors for this. Materials and Methods Microbiological specimens between June 2002 and March 2017 at five regional hospital sites were identified with revision TKA procedures in the National Joint Replacement Registry*. The time between procedures, type of revision strategy and any subsequent further revision operations were collected. Results At minimum 2-years follow-up, 174 revision TKA were identified, with a mean patient age of 69 +/- 11 years. A broad range of pathogens were identified. Fifty cases (29%) had persistent infection requiring at least one further operative procedure, 13 cases required 3 or more. Coagulase-negative Staphylococcus species (CNS) was seen most with failed surgery, polymicrobial infections also posing a significant risk factor. The best chance of a successful PJI surgical strategy was <12 months from primary TKA, with the greatest risk between 3-5 years (p<0.05). Younger age significantly increased the risk of further surgery (p<0.05). Management varied; 103 (59%) debridement, antibiotic therapy with implant retention (DAIR) with further surgery in 29%, 45 (17%) single-stage revision with further surgery in 13%, and 26 (15%) two-stage revision, with further surgery in 12%. Conclusion This study presents the most common causative pathogens for PJI in TKA, and the high rate of persistent infection after initial revision surgery. Risk factors for persistent infection and further revision surgery were polymicrobial and CNS infections, patients who presented between 3-5 years following primary TKA, and younger age. This study therefore raises important risk factors and areas for future research to reduce the burden of multiple operations.

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“…For example, the irrigation and debridement procedure has been recommended for patients with a well-fixed major prosthesis component and early PJI within 30 days of the primary operation or for acute PJIs with a symptom duration of ,3 weeks 51 . According to Nakano et al, factors such as the time of onset of symptoms after primary TKA, the type of hospital where the primary operation was performed, and the organism's resistance to methicillin are important factors that influence clinical outcomes after an infected TKA 52 . One factor contributing to the high success rate of irrigation and debridement in the present study might be the low rate of infections due to MRSA in Norway.…”

Section: Risk Factorsmentioning

confidence: 99%

Outcome of Revision Surgery for Infection After Total Knee Arthroplasty

et al. 2019

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Background: Periprosthetic joint infection (PJI) after knee arthroplasty surgery remains a serious complication, yet there is no international consensus regarding the surgical treatment of PJI. This study aimed to assess prosthesis survival rates, risk of revision, and mortality rate following different surgical strategies (1-stage versus 2-stage implant revision and irrigation and debridement with implant retention) that are used to treat PJI. Methods:The study was based on 644 total knee arthroplasties (TKAs) that were revised because of a deep infection (i.e., surgically treated PJI) and reported to the Norwegian Arthroplasty Register (NAR) from 1994 to 2016.Kaplan-Meier and multiple Cox regression analyses were performed to assess implant survival rate and risk of revision. We also studied mortality rates at 90 days and 1 year after revision for PJI.Results: During the follow-up period, 19% of the irrigation and debridement cases, 14% of the 1-stage revision cases, and 12% of the 2stage revision cases underwent a subsequent revision because of a PJI. The 5-year Kaplan-Meier survival rate with revision for infection as the end point was 79% after irrigation and debridement, 87% after 1-stage revision, and 87% after 2-stage revision. There were no significant differences between 1-stage and 2-stage revisions with subsequent revision for any reason as the end point (relative risk [RR], 1.7; 95% confidence interval [CI], 0.9 to 3.5) and no difference with revision because of infection as the end point (RR, 1.6; 95% CI, 0.7 to 3.7). In an age-stratified analysis, however, the risk of revision for any reason was 4 times greater after 1-stage revision than after 2-stage revision in patients over the age of 70 years (RR, 4.3; 95% CI, 1.3 to 14.8). Age had no significant effect on the risk of subsequent revision for knees that had been revised with the irrigation and debridement procedure. The 90-day and 1-year mortality rates after revision for PJI were 1.2% and 2.5%, respectively.Conclusions: Irrigation and debridement yielded good results compared with previous published studies. Although the 1-stage revisions resulted in a fourfold increase in risk of subsequent revision compared with the 2stage revisions in older patients, the overall outcomes after 1-stage and 2stage revisions were similar.

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Factors influencing the outcome of deep infection following total knee arthroplasty

Cited by 9 publications

References 32 publications

The Impact of Neuraxial Versus General Anesthesia on the Incidence of Postoperative Surgical Site Infections Following Knee or Hip Arthroplasty

The Impact of Neuraxial Versus General Anesthesia on the Incidence of Postoperative Surgical Site Infections Following Knee or Hip Arthroplasty

The Microbiology of Knee Prosthetic Joint Infection and its Influence on Persistent Infection

Outcome of Revision Surgery for Infection After Total Knee Arthroplasty

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