Poor outcomes of revision total knee arthroplasty in patients with septic loosening compared to patients with aseptic loosening

Baek, Ji‐Hoon; Lee, Su Chan; Jin, Hosun; Kim, Jin-Woo; Ahn, Hye Sun; Nam, Chang Hyun

doi:10.1186/s13018-021-02766-y

Cited by 10 publications

(11 citation statements)

References 22 publications

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“…The mean MINORS score was 20.5 (range, 18 to 22). Unblinded evaluation of objective and subjective end points was the main limitation that detracted from 14,18 .…”

Section: Methodological Qualitymentioning

confidence: 99%

“…Complications (Reoperation, Infection, and Failure Rates) Seven studies 9,12,14,[19][20][21][22] and 1,190 cases were included in the analysis of reoperation rates for septic and aseptic revision TKAs. Pooled data from these studies showed a higher reoperation rate for septic revision TKAs than for aseptic revision TKAs (RR, 1.98; 95% CI, 1.50 to 2.62; p < 0.00001) (Fig.…”

Section: Methodological Qualitymentioning

confidence: 99%

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Clinical Outcomes and Complications of 2-Stage Septic Versus Aseptic Revision Total Knee Arthroplasty

Kim,

Bae

2023

Journal of Bone and Joint Surgery

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Background: Although several studies have compared the clinical outcomes of septic and aseptic revision total knee arthroplasty (TKA), their results have been controversial. Therefore, this study aimed to compare clinical outcomes and complications of septic and aseptic revision TKA through a systematic review and meta-analysis. Methods: The PubMed (MEDLINE) and Embase databases were searched for studies evaluating the clinical outcomes and complications of 2-stage septic revision and aseptic revision TKAs. A systematic review of clinical outcomes (Knee Society Knee and Function Scores and range of motion) and complications (reoperation, infection, and failure rates) was conducted. Results: Thirteen studies were included in the systematic review. The mean MINORS (Methodological Index for NOn-Randomized Studies) score of the included studies was 20.5 (range, 18 to 22). The meta-analysis revealed higher reoperation (risk ratio [RR], 1.98; 95% confidence interval [CI], 1.50 to 2.62; p < 0.00001), infection (RR, 4.08; 95% CI, 2.94 to 5.64; p < 0.00001), and failure rates (RR, 2.88; 95% CI, 1.38 to 6.03; p = 0.005) in septic revision TKAs than in aseptic revision TKAs. Moreover, septic revision TKAs showed lower Knee Society Knee Scores compared with aseptic TKAs (mean difference [MD], −6.86; 95% CI, −11.80 to −1.92; p = 0.006). However, the Knee Society Function Score (MD, −1.84; 95% CI, −7.84 to 3.80; p = 0.52) and range of motion (MD, −6.96°; 95% CI, −16.23° to 2.31°; p = 0.14) were not significantly different between septic and aseptic revision TKAs. Conclusions: Despite the heterogeneity of prosthesis designs and surgical protocols used in septic and aseptic revision TKAs, the results of this systematic review suggest that 2-stage septic revision TKAs have poorer clinical outcomes and higher complication rates than aseptic revision TKAs do. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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“…The mean MINORS score was 20.5 (range, 18 to 22). Unblinded evaluation of objective and subjective end points was the main limitation that detracted from 14,18 .…”

Section: Methodological Qualitymentioning

confidence: 99%

Section: Methodological Qualitymentioning

confidence: 99%

Clinical Outcomes and Complications of 2-Stage Septic Versus Aseptic Revision Total Knee Arthroplasty

Kim,

Bae

2023

Journal of Bone and Joint Surgery

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“…Two nurses and one private doctor (see Acknowledgements) found and visited non-responders. 9,10 Clinical evaluations were performed using the Knee Society rating system. 8 Results were classified as excellent (80 to 100 points), good (70 to 79 points), fair (60 to 69 points), or poor (< 60 points).…”

Section: Methodsmentioning

confidence: 99%

Long-term outcomes of primary total knee arthroplasty in patients with hepatitis B virus infection

et al. 2022

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Aims The purpose of this study was to compare the clinical outcomes, mortalities, implant survival rates, and complications of total knee arthroplasty (TKA) in patients with or without hepatitis B virus (HBV) infection over at least ten years of follow-up. Methods From January 2008 to December 2010, 266 TKAs were performed in 169 patients with HBV (HBV group). A total of 169 propensity score–matched patients without HBV were chosen for the control group in a one-to-one ratio. Then, the clinical outcomes, mortalities, implant survival rates, and complications of TKA in the two groups were compared. The mean follow-up periods were 11.7 years (10.5 to 13.4) in the HBV group and 11.8 years (11.5 to 12.4) in the control group. Results The mean Knee Society scores in the HBV and control groups improved from 37.1 (SD 5.6) and 38.4 (SD 5.4) points preoperatively to 78.1 (SD 10.8) and 81.7 (SD 10.2) points at final follow-up (p = 0.314), while the mean function scores in the HBV and control groups improved from 36.2 and 37.3 points preoperatively to 77.8 and 83.2 points at final follow-up (p = 0.137). Nine knees in the HBV group required revision surgery, including seven due to septic loosening and two due to aseptic loosening. Four knees in the control group required revision surgery, including three due to septic loosening and one due to aseptic loosening. Kaplan–Meier survivorship analysis with the revision of either component as an endpoint in the HBV and control groups estimated 96.6% and 98.5% chances of survival for ten years, respectively (p = 0.160). Conclusion TKA in patients with HBV infection resulted in good clinical outcomes and survivorship. However, there was a higher revision rate over a minimum ten-year follow-up period compared to TKA in patients without HBV infection. Cite this article: Bone Jt Open 2022;3(6):470–474.

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“…In the remaining 10 studies, 2-stage revision TKA was performed for septic failure [19][20][21][22][23][24][25][26][27][28] . In the analysis pooling these studies (395 septic revision TKA cases and 975 aseptic revision TKA cases), the infection rate was also significantly higher in the septic revision TKA group (OR, 4.14; 95% CI, 2.33 to 7.36; p < 0.00001; I 2 = 22%) (Fig.…”

Section: Infection Rates After Revision Tkamentioning

confidence: 99%

“…Finally, when 287 cases of septic revision TKA and 339 cases of revision TKA for aseptic loosening were compared 9,18,[25][26][27] , the infection rate was again higher in the septic revision TKA group (OR, 4.45; 95% CI, 2.28 to 8.70; p < 0.0001; I 2 = 0%) (Fig. 4).…”

Section: Infection Rates After Revision Tkamentioning

confidence: 99%

Risk of Infection After Septic and Aseptic Revision Total Knee Arthroplasty

Lee,

Kim,

Park

et al. 2023

Journal of Bone and Joint Surgery

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Background: The causes of primary total knee arthroplasty (TKA) failure can be divided into septic and aseptic etiologies. It is unclear whether the etiology affects the infection rate after revision TKA. This systematic review was conducted to evaluate whether there is a difference in infection rates between septic and aseptic revision TKA. We hypothesized that infection rates would be higher after septic revision TKA. Methods: The PubMed and Embase databases and the Cochrane Library were searched to find studies evaluating infection rates following septic and aseptic revision TKA. We included studies that compared the postoperative infection rates of a group that received revision TKA for aseptic failure and a group that received 1- or 2-stage revision TKA for septic failure. Studies on re-revision TKA and on revision surgery after partial knee arthroplasty were excluded, as were studies of debridement, antibiotics, and implant retention (DAIR). Results: Twelve studies were included in this systematic review. In studies in which 1- or 2-stage revision TKA was performed for septic failure, septic revision TKA had a significantly higher infection rate than aseptic revision TKA (odds ratio [OR], 6.83; 95% confidence interval [CI], 1.54 to 30.33; p = 0.01). Similarly, in studies in which 2-stage revision TKA was performed for septic failure, septic revision TKA had a significantly higher infection rate than aseptic revision TKA (OR, 4.14; 95% CI, 2.33 to 7.36; p < 0.00001). In the comparison of revision TKA for aseptic loosening and septic revision TKA, septic revision TKA had a higher infection rate than aseptic revision TKA (OR, 4.45; 95% CI, 2.28 to 8.70; p < 0.0001). Conclusions: Overall, septic revision TKA had a higher infection rate than aseptic revision TKA. Even when 2-stage revision TKA was performed for septic failure, the infection rate was higher after septic revision TKA than after aseptic revision. Surgeons should explain the relatively high infection rates to patients undergoing revision TKA for septic failure of their primary joint replacement. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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Poor outcomes of revision total knee arthroplasty in patients with septic loosening compared to patients with aseptic loosening

Cited by 10 publications

References 22 publications

Clinical Outcomes and Complications of 2-Stage Septic Versus Aseptic Revision Total Knee Arthroplasty

Clinical Outcomes and Complications of 2-Stage Septic Versus Aseptic Revision Total Knee Arthroplasty

Long-term outcomes of primary total knee arthroplasty in patients with hepatitis B virus infection

Risk of Infection After Septic and Aseptic Revision Total Knee Arthroplasty

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