Outcomes of Primary Total Knee Arthroplasty Following Septic Arthritis of the Native Knee

Abstract

Background: Septic arthritis of the native knee often results in irreversible joint damage leading to the need for total knee arthroplasty (TKA). The purpose of the present study was to examine the intermediate-term risk of periprosthetic joint infection (PJI), aseptic revision, and reoperation following primary TKA in patients with a history of septic arthritis of the native knee as compared with primary TKA performed for the treatment of osteoarthritis. Methods:We retrospectively identified 215 primary TKAs performed from 1971 to 2016 at a single institution in patients with a history of septic arthritis of the native knee. Each case was matched 1:1 based on age, sex, body mass index (BMI), and surgical year to a TKA for osteoarthritis. The mean age and BMI were 63 years and 30 kg/m 2 , respectively. The mean duration of follow-up was 9 years.Results: Survivorships free of PJI at 10 years were 90% and 99% for the septic arthritis and osteoarthritis groups, respectively (hazard ratio [HR] = 6.1; p < 0.01). Ten-year survivorships free of any aseptic revisions were 83% and 93% (HR = 2.5; p < 0.01), and survivorships free of any reoperation were 61% and 84% (HR = 2.9; p < 0.01) for the septic arthritis and osteoarthritis groups, respectively. In addition, as time from the diagnosis of native knee septic arthritis to TKA increased, the relative risk of subsequent infection decreased. Preoperative and 2-year postoperative Knee Society scores were similar between the groups (p = 0.16 and p = 0.19, respectively).Conclusions: There was a 6.1-fold increased risk of PJI in patients undergoing TKA with a history of native knee septic arthritis when compared with controls undergoing TKA for the treatment of osteoarthritis, with a cumulative incidence of 9% at 10 years. Subgroup analysis of the septic arthritis cohort revealed a higher risk of any infection in patients who underwent TKA within the first 5 to 7 years after the diagnosis of septic arthritis as compared with those with a greater duration. Moreover, the 10-year rates of survival free of aseptic revision, any revision, and any reoperation were significantly worse in the native knee septic arthritis cohort.Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. Septic arthritis of the native knee is an orthopaedic emergency that may lead to destruction of articular cartilage and bone, and, if untreated, even death 1 . The incidence of septic arthritis of the native joint has been estimated to be 2 per 100,000 per year 2 . Approximately 25% to 50% of patients with septic arthritis of the native knee will develop irreversible joint damage (Fig. 1), in some cases necessitating total knee arthroplasty (TKA) 3,4 .Previously reported rates of periprosthetic joint infection (PJI) after TKA in patients with previous septic arthritis of the native knee have ranged from 3% to 15%, whereas the overall rate of PJI following TKA is approximately 1% [5][6][7][8] . Most reports on septic arthritis of the native knee...

Arthroplasty after septic arthritis of the native hip and knee: retrospective analysis of 49 joints

“…The expert panel of the 2019 International Consensus on Orthopedic Infections emphasized the heterogeneity of SA-arthroplasty intervals, joint or bone involvements, the sites, and microorganisms in the publications available, which limited their conclusions and left them open to debate (Aalirezaie et al, 2019). Moreover, a recent case-control study involving 215 primary TKA (Bettencourt et al, 2021) revealed a 6.1-fold increased risk of PJI in patients undergoing TKA with a history of native knee SA when compared with controls undergoing TKA for osteoarthritis, with a cumulative incidence of 9 % at 10 years. Bettencourt et al (2022) did the same case-control study on the hip and found a 10-fold increased risk of PJI in patients with a history of SA.…”

Arthroscopic Treatment Yields Lower Reoperation Rates than Open Treatment for Native Knee but Not Native Shoulder Septic Arthritis

“…These findings are significant, as patients who undergo arthroplasty following septic arthritis have been shown to have strikingly poorer outcomes than those undergoing arthroplasty for osteoarthritis. 21 …”

Packing with alpha-tricalcium phosphate followed by curettage and phenol-ethanol ablation for appendicular giant cell tumor of bone

“…[16,19] Additionally, secondary osteoarthritis has several complications after total arthroplasty compared with primary osteoarthritis. [16,20] Therefore, prevention of secondary osteoarthritis is needed to improve patient's quality of life.…”

“…[6,[16][17][18] Secondary osteoarthritis is a serious problem that leads to pain, limping gait, and additional surgery, which comprises total arthroplasty and osteotomy. [16,19] Additionally, secondary osteoarthritis has several complications after total arthroplasty compared with primary osteoarthritis. [16,20] Therefore, prevention of secondary osteoarthritis is needed to improve patient's quality of life.…”