Failure following revision total knee arthroplasty: infection is the major cause

Mortazavi, Seyed Mohammad Javad; Molligan, Jeremy; Austin, Matthew S.; Purtill, James J.; Hozack, William J.; Parvızı, Javad

doi:10.1007/s00264-010-1134-1

Cited by 184 publications

(121 citation statements)

References 41 publications

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“…It is well documented that patients with obesity have more frequent complications and a greater risk of revision after primary TKA [4,5,14,15]. As the prevalence of obesity increases, these complications will continue to create The estimated survival free of subsequent revision was 81% (95% CI, 70%-92%) for the patients in the morbid obesity group and 93% (95% CI, 86%-100%) for patients in the nonmorbid obesity group at 10 years (p = 0.02).…”

Section: Discussionmentioning

confidence: 86%

Morbid Obesity: Increased Risk of Failure After Aseptic Revision TKA

Watts

Wagner

Houdek

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Patients with obesity are known to have a higher risk of complications after primary TKA; however, there is a paucity of data regarding the effects of obesity with revision TKAs. Questions/purposes We asked the following questions : (1) Are patients with morbid obesity (BMI C 40 kg/m 2 ) at greater risk for repeat revision, reoperation, or periprosthetic joint infection (PJI) compared with patients without obesity (BMI \ 30 kg/m 2 ) after an index revision TKA performed for aseptic reasons? (2) Do patients who are not obese achieve higher Knee Society pain and function scores after revision TKA for aseptic reasons? Methods We used a retrospective cohort study with 1:1 matching for sex, age (± 3 years) and date of surgery (± 1 year) to compare patients with morbid obesity with patients without obesity with respect to repeat revision, reoperation, and PJI. Using our institution's total joint registry, we identified 1291 index both-component (femoral and tibial) aseptic revision TKAs performed during a 15-year period (1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007). Of these, 120 revisions were in patients with morbid obesity (BMI C 40 kg/ m 2 ) and 624 were in patients with a BMI less than 30 kg/ m 2 . We then considered only patients with a minimum 5-year followup, which was available for 77% of patients with morbid obesity and 76% of patients with a BMI less than 30 kg/m 2 (p = 0.84). All patients with morbid obesity who met criteria were included (morbid obesity group: n = 93; average followup, 7.9 years) and compared with a matched cohort of patients with a BMI less than 30 kg/m 2 (nonmorbid obesity group: n = 93; average followup, 7.3 years). Medical records were reviewed to gather details regarding complications and clinical outcomes. Results Overall, patients with morbid obesity had an increased risk of repeat revision (hazard ratio [HR], 3.8; 95% CI, 1.2-16.5; p \ 0.02), reoperation (HR, 2.9; 95% CI, 1.3-7.4; p \ 0.02), and PJI (HR, 6.4; 95% CI, 1.2-119.7; p \ 0.03). Implant survival rates were 96% (95% CI, 92%-100%) and 100% at 5 years, and 81% (95% CI, 70%-92%) and 93% (95% CI, 86%-100%) at 10 years for the patients with morbid obesity and those without morbid obesity, respectively (p = 0.02). At 10 years, The Knee Society pain (90 [95% CI,(88)(89)(90)(91)(92) Conclusion Morbid obesity is associated with increased rates of rerevision, reoperation, and PJI after aseptic revision TKA. As the time-sensitive nature of revision surgery may not always allow for patient or comorbidity optimization, these results emphasize the need for improving our care of patients with morbid obesity earlier on during

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Section: Discussionmentioning

confidence: 86%

Morbid Obesity: Increased Risk of Failure After Aseptic Revision TKA

Watts

Wagner

Houdek

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…If a mean reinfection rate is 10% and a difference of 5% would be clinically meaningful, 450 patients per group would reach a power of at least 80% with a CI of 95%. Considering the 0.7% to 2% incidence of prosthetic knee infections [65,66,72,78,82], this would be unrealistic. Second, a comparison of all the surgical exposures described [97,104], was not performed for same reason.…”

Section: Discussionmentioning

confidence: 99%

Tibial Tubercle Osteotomy or Quadriceps Snip in Two-stage Revision for Prosthetic Knee Infection? A Randomized Prospective Study

Bruni

Iacono

Sharma

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Although 7% to 38% of revision total knee arthroplasties (RTKAs) are attributable to prosthetic knee infections, controversy exists regarding the best surgical approach while reducing the risk of extensor mechanism complications and the reinfection rate. Questions/purposes We compared The Knee Society Score Ó (KSS), incidences of complications, maximum knee flexion, residual extension lag, and reinfection rate in patients with prosthetic knee infections treated with two-stage RTKAs using either the tibial tubercle osteotomy (TTO) or the quadriceps snip (QS) for exposure at the time of reimplantation. Methods We prospectively followed 81 patients with chronic prosthetic knee infections treated between 1997 and 2004. Patients were randomized to receive a TTO or QS for exposure at the time of reimplantation. All patients had the same rehabilitation protocol. The minimum followup was 8 years (mean, 12 years; range, 8-15 years). Results Patients in the TTO group had a higher mean KSS than the QS group (88 versus 70, respectively). Mean maximum knee flexion was greater in the TTO group (113°v ersus 94°); with a lower incidence of extension lag (45% versus 13%). We observed no differences in reinfection rate between groups. Conclusions We found the TTO combined with an early rehabilitation protocol associated with superior KSS did not impair extensor mechanism function or increase the reinfection rate. We believe a two-stage RTKA with TTO is a reasonable approach for treating prosthetic knee infections.

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“…Infections are the main cause of failure after prosthetic revision as revealed by recent studies with a risk that may be 10-fold higher than primary procedures [54,55]. We recommend the use of synthetic materials to reinforce the apparatus, when a direct repair is not possible.…”

Section: Discussionmentioning

confidence: 92%

Reconstruction of patellar tendon following implantation of proximal tibia megaprosthesis for the treatment of post-traumatic septic bone defects

Mazza

Vaienti

Mazzola

et al. 2016

Injury

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Introduction: Latest advances made in joint replacement implants allows reconstruction of entire limbs. These special prostheses or megaprostheses were originally designed for the treatment of severe oncological bone loss. Nowadays, however, the indications and applications of these devices are expanding to other orthopaedic and trauma clinical conditions. Since 2008 we have implanted 152 megaprostheses in non-oncological conditions: 87 were implanted for post-traumatic failures aseptic/septic (represented by complex non-unions and critical size bone defects); 26 total femur, 52 distal femur and 9 proximal tibia. In this group of patients bone and soft tissues conditions are completely different compared to patients with oncological back ground. The presence of infection and previous surgeries can lead to adhesion, scar interference, muscular and tendon impairment and skin problems that lead to reduced function and severe joint stiffness. The purpose of this study is to evaluate the results of treatment of reconstruction of patellar tendon during implantation of proximal tibia megaprosthesis for the treatment of septic post traumatic critical bone defects. Patients and methods: In this retrospective study, we evaluated 9 patients treated with proximal tibia megaprosthesis who underwent patellar tendon reconstruction. All patients presented a complete patellar tendon disruption at the time of prosthesis implantation. Procedures of reconstruction included a tendon-plasty of quadriceps and/or patellar tendons, a pie crusting of quadriceps fascia, a reinforcement of the apparatus with synthetic tendon graft substitutes (LARS) and a medial gastrocnemius muscular flap to reconstruct the extensor mechanism and obtain skin coverage when needed. The average follow up was 18 months (9-36). For each of the cases, we analysed the complications occurred regarding septic recurrence, patellar fracture, quadriceps and patellar tendon rupture and number of reinterventions. The clinical outcome was assessed by the WOMAC Score. Results: In all cases there was no infection recurrence or skin related problems. None of the patients require prosthesis revision due to loosening or device failure. No patellar fracture or quadriceps tendon failure was recorded. One patient presented a rupture of the reconstructed patellar tendon due to a trauma incident 18 months after the implantation and he required revision surgery. From a clinical point of view the average WOMAC score was 62.4 at 1 month rising to 72.6 at 3 months, 78.2 at 6 months, 76.4 at 1 year and 74.8 at 18 months. Conclusion: When proximal tibia megaprosthesis is implanted and there are soft tissue and patellar tendon deficiency, soft tissue reconstruction can be achieved by appropriate lengthening of the tendon and a gastrocnemius flap reinforced by LARS. Such an approach allows restoration of the extensor mechanism and coverage of the prosthesis in an area where skin problems are frequently very common.

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Failure following revision total knee arthroplasty: infection is the major cause

Cited by 184 publications

References 41 publications

Morbid Obesity: Increased Risk of Failure After Aseptic Revision TKA

Morbid Obesity: Increased Risk of Failure After Aseptic Revision TKA

Tibial Tubercle Osteotomy or Quadriceps Snip in Two-stage Revision for Prosthetic Knee Infection? A Randomized Prospective Study

Reconstruction of patellar tendon following implantation of proximal tibia megaprosthesis for the treatment of post-traumatic septic bone defects

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