Risk factors for early septic failure after two-stage exchange total knee arthroplasty for treatment of periprosthetic joint infection

Abstract

Background The cause of early septic failure after two-stage exchange revision total knee arthroplasty (TKA) for chronic periprosthetic joint infection (PJI) and the factors affecting it are not well known. The purpose of this study was to determine the surgical outcomes and the risk factors for early septic failure after two-stage revision TKA for chronic PJI. Methods We identified a total of 246 adult patients who met the Musculoskeletal Infection Society (MSIS) diagnostic criteria for chronic PJI at two academic tertiary hospitals from March 2012 to December 2018. Finally, 151 patients who consecutively received two-stage exchange revision TKA for chronic PJI and who had a minimum 3-year follow-up were enrolled and retrospectively reviewed. Successful surgical treatment was evaluated for two-stage revision TKA and risk factors for early septic failure were identified. Results Early septic failures occurred within 3 years after reimplantation in 48 patients (31.8%). After accounting for potentially confounding variables, we found that male patient [odds ratio (OR): 2.753, 95% confidence interval (CI) 1.099–6.893, p = 0.031], fungus or mycobacterial infection (OR: 5.224, 95% CI 1.481–18.433, p = 0.01), and positive culture at reimplantation (OR: 4.407, 95% CI 1.255–15.480, p = 0.021) were independently associated with early septic failure after two-stage exchange revision TKA. Conclusion Male patients, fungus or mycobacterial infection, and positive culture at reimplantation were independently associated with an increased risk of early septic failure after two-stage exchange revision TKA despite normal C-reactive protein values prior to reimplantation. Further prospective and high-quality studies are needed to determine the risk factors of two-stage exchange revision TKA for chronic PJI. Level of evidence: level IV; retrospective comparison; treatment study.

Mouldable Collagen–Tricalciumphosphate Is a Safe Carrier for Local Antibiotics—Short-Term Results in Revision Hip Arthroplasty

“…In this context, with a megaprostheis reconstruction in 32 (40%) of the patients, the revision risk encountered appears to be acceptable, although patients must be advised that wound drainage with the need for revision could be aggravated if local antibiotic carriers using this composite bone substitute are used. Although several risk factors are known for re-revisions or persistent PJI, in this study, the authors are not able to validate these findings due to the smaller sample size [ 35 ].…”

Upcoming evidence in clinical practice of two-stage revision arthroplasty for prosthetic joint infection

“…In fact, ERS and CRP have an important role in diagnosing PJI, but their value in assessing infection cure at the time of reimplantation has been brought into question, as the relationship between a negative value of these biomarkers and microbiologic eradication is controversial, particularly when the strategy associated with the highest success rate (continuous therapy strategy) is adopted [ 53 ]. Moreover, microbiologic investigations at the time of reimplantation cannot be considered effective in diagnosing or excluding infection persistence, and their value should be contextualized [ 54 ].…”