Influence of Gender on Occurrence of Aseptic Loosening and Recurrent PJI after Revision Total Knee Arthroplasty

Abstract

Background: Periprosthetic joint infection (PJI) is a common yet severe complication after total knee arthroplasty (TKA). Surgical intervention and antibiotic therapy are obligatory to achieve successful, infection-free outcome. Compared to the outcomes after primary TKA, prosthesis failure rates are drastically increased after PJI-dependent revision surgery. Recurrent PJI and aseptic loosening are the most common reasons for prosthesis failure after revision TKA. An open question is the influence of the patients’ gender on long-term prosthesis survival after revision surgery. Additionally, it is unknown whether gender-related parameters and risk factors or differences in treatment are responsible for potential differences in outcome after revision arthroplasty. Patients and Methods: In this report, 109 patients that received TKA revision surgery due to PJI were retrospectively analyzed. We used clinical, paraclinical and radiological examinations to study the influence of gender on the long-term complications aseptic loosening and recurrent PJI after PJI-dependent revision arthroplasty. Results: While overall prosthesis failure rates and risk of recurrent PJI did not differ between genders, the long-term risk of aseptic loosening was significantly elevated in female patients. Postoperative coronal alignment was significantly more varus for women later diagnosed with aseptic loosening. Besides coronal alignment, no gender-dependent differences in clinical presentation or treatment were observed. Conclusions: Female patients displayed a significantly increased risk for aseptic loosening after PJI-dependent revision TKA. The observed gender-dependent differences in long-term outcome in our study support theories surrounding the role of bone metabolism in the development of aseptic loosening. Our data suggest that further research on a female design for PJI-dependent revision prostheses is warranted.

Candida periprosthetic joint infections — risk factors and outcome between albicans and non-albicans strains

“…For revision surgery, one-, two-, or multiple-stage exchange surgery was performed as previously described [15,33,34]. After removal of the infected prosthesis, patients received a temporary, antibiotic-loaded cement spacer between stages in case of two-or multiple-stage exchange surgery.…”

Inflammation of Bone in Patients with Periprosthetic Joint Infections of the Knee

“…While the pathomechanisms responsible are largely unknown, osteoimmunological pathways in general and a proinflammatory environment in particular have been suggested to be pivotal for disease progression and long-term failure 6 , 7 . Further evidence of the role of altered bone metabolism is provided by sex-dependent differences, in that women are significantly more at risk for aseptic loosening after PJI revision surgery 20 . To our knowledge, the present study is the first to investigate the effect of PJI on the surrounding skeletal component in humans and to provide evidence of the occurrence of osteitis in the bone surrounding the total knee replacement.…”

Serum and Synovial Markers in Patients with Rheumatoid Arthritis and Periprosthetic Joint Infection

“…In our study, we found prosthesis failure rates after revision arthroplasty to be significantly elevated in patients with rheumatoid arthritis, further stressing the need for a more personalized diagnostic and therapeutic approach in these patients. Similarly, prosthesis survival rates after revision arthroplasty have been found to be significantly decreased in non-rheumatoid arthritis patients [ 11 , 12 , 33 ].…”

“…In any of these cases, treatment is an enormous burden for patients [ 9 ]. In addition to surgical intervention, exchange arthroplasty can significantly impact joint function, cause pain, and has an increased risk of prosthesis failure [ 10 , 11 , 12 ].…”