Outcome of infected total knee arthroplasty

Kramhøft, M; Bødtker, Søren; Carlsen, Agnete

doi:10.1016/0883-5403(94)90115-5

Cited by 41 publications

(12 citation statements)

References 11 publications

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“…Two-stage revision is still the gold standard for treatment of PJI, although one-stage revisions may achieve similar results in special conditions [24–28]. Nevertheless, reinfection rates vary from 4 to 50 % [3, 4, 11–16]. Among the patients included in the present study, successful treatment was achieved in 55 (93.2 %) after a mean follow-up period of 4.1 years.…”

Section: Discussionmentioning

confidence: 86%

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Eradication rates, risk factors, and implant selection in two-stage revision knee arthroplasty: a mid-term follow-up study

et al. 2016

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BackgroundTwo-stage revision (TSR) knee arthroplasty is an established treatment, but failure to control infection still occurs in 4–50 % of cases. The aim of this study was to assess the infection eradication rate, risk factors for failure, and the clinical outcome after two-stage revision knee arthroplasty.MethodsThis retrospective study included 59 patients who had undergone at least one two-stage revision procedure due to periprosthetic joint infection (PJI). Demographic data, comorbidities, types of implant, and complications were analyzed. Univariate and multivariate logistic regression analysis were used to identify risk factors for failure.ResultsThe infections were controlled in 55 patients (93.2 %). The follow-up period was 4.1 (±2.7) years. Infection control was achieved after the first TSR in 42 patients (71.2 %) and after the second TSR in 13 (76.5 %). The percentage of arthrodesis procedures in patients with infection control increased from 16.75 % after one TSR to 69.2 % after two TSRs. Multivariate logistic regression analysis identified body mass index (BMI) (odds ratio 1.22; 95 % confidence intervals, 1.07 to 1.40; p = 0.004) and smoking (OR 21.52; 95 % CI, 2.60 to 178.19; p = 0.004) as risk factors for failure.ConclusionsTwo-stage revision protocols can achieve acceptable results even after a second procedure. It is still unclear whether the choice of implant influences failure rates. Risk factors for failure after two-stage revision were identified. Studies with larger sample sizes are needed in order to support these findings and identify further risk factors. To reduce failure rates, programs should be established to treat or minimize risk factors in patients with PJI.

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Section: Discussionmentioning

confidence: 86%

“…Reinfection rates reported in the literature range from 4 to 50 % [3, 4, 11–16]. Only a few studies have analyzed the factors that have a negative impact on infection control after TSR [17–20].…”

Section: Introductionmentioning

confidence: 99%

Eradication rates, risk factors, and implant selection in two-stage revision knee arthroplasty: a mid-term follow-up study

et al. 2016

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“…However, similar to the findings of Fehring et al [6] and Vessely et al [28], both of whom reported infection as a frequent mode of TKA failure, our data indicate that prosthetic joint infection is currently the most common indication for revision TKA in the United States. This is particularly concerning, especially given the substantial resources required to treat prosthetic joint infections, and the relatively poor patient outcomes that have been reported with both single-and two-stage revision TKA for infection compared with the results of revision TKA for aseptic causes of failure [1,7,13,24,29]. As the number of primary TKA procedures performed in the next two decades is expected to rise exponentially [14], increased resources should be devoted to research investigation and product development focused on prevention, early diagnosis, and treatment of prosthetic joint infection.…”

Section: Resultsmentioning

confidence: 99%

The Epidemiology of Revision Total Knee Arthroplasty in the United States

Bozic¹,

Kurtz²,

Lau³

et al. 2009

The Journal of Arthroplasty

102

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Understanding the cause of failure and type of revision total knee arthroplasty (TKA) procedures performed in the United States is essential in guiding research, implant design, and clinical decision making in TKA. We assessed the causes of failure and specific types of revision TKA procedures performed in the United States using newly implemented ICD-9-CM diagnosis and procedure codes related to revision TKA data from the Nationwide Inpatient Sample (NIS) database. Clinical, demographic, and economic data were reviewed and analyzed from 60,355 revision TKA procedures performed in the United States between October 1, 2005 and December 31, 2006. The most common causes of revision TKA were infection (25.2%) and implant loosening (16.1%), and the most common type of revision TKA procedure reported was all component revision (35.2%). Revision TKA procedures were most commonly performed in large, urban, nonteaching hospitals in Medicare patients ages 65 to 74. The average length of hospital stay (LOS) for all revision TKA procedures was 5.1 days, and the average total charges were $49,360. However, average LOS, average charges, and procedure frequencies varied considerably by census region, hospital type, and procedure performed.

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“…Hospitalization costs contribute to the overall economic burden of patients with an infected arthroplasty [24,27]. Outcomes after revision TKAs for patients with periprosthetic joint infection are worse than for patients with aseptic knee revision [2,15,20,50,59].…”

Section: Discussionmentioning

confidence: 99%

Comparative Epidemiology of Revision Arthroplasty: Failed THA Poses Greater Clinical and Economic Burdens Than Failed TKA

Bozic

Kamath

Ong

et al. 2015

Clinical Orthopaedics &Amp; Related Research

384

235

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Background Revision THA and TKA are growing and important clinical and economic challenges. Healthcare systems tend to combine revision joint replacement procedures into a single service line, and differences between revision THA and revision TKA remain incompletely characterized. These differences carry implications for guiding care and resource allocation. We therefore evaluated epidemiologic trends associated with revision THAs and TKAs. Questions/purposes We sought to determine differences in (1) the number of patients undergoing revision TKA and THA and respective demographic trends; (2) differences in the indications for and types of revision TKA and THA; (3) differences in patient severity of illness scoring between THA and TKA; and (4) differences in resource utilization (including cost and length of stay [LOS]) between revision THA and TKA. Methods The Nationwide Inpatient Sample (NIS) was used to evaluate 235,857 revision THAs and 301,718 revision TKAs between October 1, 2005 and December 31, 2010. Patient characteristics, procedure information, and resource utilization were compared across revision THAs and TKAs. A revision burden (ratio of number of revisions to total number of revision and primary surgeries) was calculated for hip and knee procedures. Severity of illness scoring and cost calculations were derived from the NIS. As our study was principally descriptive, statistical analyses generally were not performed; however, owing to the large sample size available to us through this NIS analysis, even small observed differences presented are likely to be highly statistically significant.One or more of the authors (SMK, KO, EL) are employees of Exponent, Inc, Menlo Park, CA, USA, and Philadelphia, PA, USA. One of the authors certifies that he (DJB), or a member of his or her immediate family, has received or may receive payments or benefits, during the study period, an amount in excess of USD 100,001-USD 1,000,000, from DePuy Orthopaedics, Inc (Warsaw, IN, USA). One of the authors (TPV) certifies that he has received or may receive payments or benefits, during the study period, an amount in excess of USD 10,001-USD 100,000 from DePuy Orthopaedics, Inc (Warsaw, IN, USA). One of the authors (HER) certifies that he has received or may receive payments or benefits, during the study period, an amount in excess of USD 100,001-USD 1,000,000, from Zimmer, Inc (Warsaw, IN, USA Clin Orthop Relat Res (2015) 473:2131-2138 DOI 10.1007/s11999-014-4078-8 Clinical Orthopaedics and Related Research ® A Publication of The Association of Bone and Joint Surgeons®Results Revision TKAs increased by 39% (revision burden, 9.1%-9.6%) and THAs increased by 23% (revision burden, 15.4%-14.6%). Revision THAs were performed more often in older patients compared with revision TKAs. Periprosthetic joint infection (25%) and mechanical loosening (19%) were the most common reasons for revision TKA compared with dislocation (22%) and mechanical loosening (20%) for revision THA. Full (all-component) revision was more common i...

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Outcome of infected total knee arthroplasty

Cited by 41 publications

References 11 publications

Eradication rates, risk factors, and implant selection in two-stage revision knee arthroplasty: a mid-term follow-up study

Eradication rates, risk factors, and implant selection in two-stage revision knee arthroplasty: a mid-term follow-up study

The Epidemiology of Revision Total Knee Arthroplasty in the United States

Comparative Epidemiology of Revision Arthroplasty: Failed THA Poses Greater Clinical and Economic Burdens Than Failed TKA

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