Failure analysis of infection persistence after septic revision surgery: a checklist algorithm for risk factors in knee and hip arthroplasty

Kilgus, Sofia; Karczewski, Daniel; Passkönig, Cindy; Winkler, Tobias; Akgün, Doruk; Perka, Carsten; Müller, Michael

doi:10.1007/s00402-020-03444-0

Cited by 9 publications

(2 citation statements)

References 31 publications

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“…Using individual patient characteristics and adequate treatment algorithms, a more individual approach for the selection of patients for either one- or two-stage revision can be achieved. Recently, Kilgus et al [ 30 ] studied patient independent factors for infection persistence following failed septic revisions. In 85% of failed cases, patient independent factors could be identified, in which failure was most frequently caused by inadequate treatment algorithms.…”

Section: Discussionmentioning

confidence: 99%

Reinfection rates after one- and two-stage revision surgery for hip and knee arthroplasty: a systematic review and meta-analysis

Goud

Harlianto

Ezzafzafi

et al. 2021

Arch Orthop Trauma Surg

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Purpose Revisions for periprosthetic joint infection of knee and hip arthroplasty can be performed following one- or two-stage treatment protocols. Current literature is inconclusive whether one protocol is superior to the other, as prior literature reported similar reinfection rates for both treatment options. We aimed to provide a systematic review and meta-analysis of current literature on septic arthroplasty revisions. Methods Between April 2015 and December 2020, Medline, Embase, and The Cochrane Library were searched for studies reporting reinfection outcomes in patients treated with one-stage and two-stage knee or hip revision arthroplasty. Two reviewers independently extracted data and disagreements were resolved by a third investigator. We utilized a double arcsine transformation, prior to pooling using a random-effects model. Results For hip revision arthroplasty, we identified 14 one-stage studies (n = 1237) with a pooled reinfection rate of 5.7% (95% CI 3.7–8.1%), and 46 two-stage studies (n = 5009) with a reinfection rate of 8.4% (95% CI 6.9–9.9%). For knee revision arthroplasty, 6 one-stage studies (n = 527) and 48 two-stage studies (n = 4344) were identified with reinfection rates of 12.7% (7.0–19.7%) and 16.2% (13.7–19.0%), respectively. Overall, reinfection rates did not vary substantially after subgroup analysis. Limitations of our study are the limited amount of one-stage studies that introduce a potential bias. Conclusion The reinfection rates following one- and two-stage hip and knee arthroplasty revisions were similar. Knee reinfection rates have increased compared to the previous analysis. Individual patient characteristics and adequate treatment algorithms are needed for a more individual selection approach, until a randomized trial is performed.

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Section: Discussionmentioning

confidence: 99%

Reinfection rates after one- and two-stage revision surgery for hip and knee arthroplasty: a systematic review and meta-analysis

Goud

Harlianto

Ezzafzafi

et al. 2021

Arch Orthop Trauma Surg

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“…All these risk factors are likely to inhibit soft tissue as well as bone quality and, therefore, favor PJI persistence or reoccurrence in multiple revision situations. Besides patient-specific risk factors, inadequate antibiotic or surgical treatment has been shown to favor PJI persistence [32]. Additionally, undiagnosed periprosthetic infections (three cases presented in our study population), certainly represent a considerable risk for persistent or questionable new infections with a high…”

Section: Discussionmentioning

confidence: 83%

Failure Analysis in Multiple TKA Revisions—Periprosthetic Infections Remain Surgeons’ Nemesis

Kirschbaum

Erhart

Perka

et al. 2022

JCM

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Background: The aim of this study was to categorize reasons for failure and to analyze the survivorship of multiple total knee arthroplasty (TKA) revisions. Methods: The study retrospectively evaluated all multiple TKA revisions performed between 2005 and 2015 at the authors’ institutions. Sixty-three patients (35 female, 28 male, age 64 ± 10 years, follow-up 55 ± 36 months) underwent a total of 157 re-revision TKA surgeries (range 2–5). The revision indications were divided up into main diagnoses. Survivorship was evaluated by mixed model analysis. Results: The main overall reason for re-revision was periprosthetic joint infection (PJI) (48%), followed by instability (12%), polyethylene wear (11%), malpositioning (8%), and aseptic loosening (8%). Survivorship shortened with an increasing number of revision surgeries (p = 0.003). While PJI was in 38% of all cases, the reason for the first revision, incidence increased constantly with the number of revisions (48% at second revision, 55% at third revision, 86% at fourth revision, and 100% at fifth revision, p = 0.022). If periprosthetic infection caused the first revision, patients showed an average of two more septic revisions at follow-up than patients with an aseptic first revision indication (p < 0.001). In 36% of cases, the reason for follow-up surgery in case of periprosthetic infection was again PJI. Conclusion: The probability of survival of the implanted knee arthroplasty is significantly reduced with each subsequent revision. Periprosthetic infection is the main cause of multiple revisions.

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Periprothetische Früh- und Spätinfektionen

2020

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Failure analysis of infection persistence after septic revision surgery: a checklist algorithm for risk factors in knee and hip arthroplasty

Cited by 9 publications

References 31 publications

Reinfection rates after one- and two-stage revision surgery for hip and knee arthroplasty: a systematic review and meta-analysis

Reinfection rates after one- and two-stage revision surgery for hip and knee arthroplasty: a systematic review and meta-analysis

Failure Analysis in Multiple TKA Revisions—Periprosthetic Infections Remain Surgeons’ Nemesis

Periprothetische Früh- und Spätinfektionen

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