Two-Stage Total Knee Arthroplasty for Prosthetic Joint Infection

Abstract

PurposeThis retrospective review was conducted to identify prognostic factors for two-stage reimplantation for infected total knee arthroplasty (TKA) and the rate of reinfection following revision TKA.Materials and MethodsOut of 88 patients diagnosed with post-TKA infection between 1998 and 2011, 76 underwent two-stage reimplantation and were reviewed in this study. The 76 patients were divided into two groups-those who experienced reinfection and those who did not. Comorbidities, culture results, and inflammation indices were analyzed and compared between the two groups.ResultsOf the 76 patients who underwent a two-stage reimplantation, 18 (23.7%) experienced reinfection. Patients with more than three comorbidities had significantly higher reinfection rates than those with less than three comorbidities (47.1% vs. 4.8%, p=0.032). The reinfection rate between the culture positive prosthetic joint infection group and the culture negative prosthetic joint infection group was not significantly different (p=0.056). Inflammation indices (erythrocyte sedimentation rate [ESR] and C-reactive protein [CRP]) showed a statistically significant difference between patients with reinfection and those without reinfection at 4 weeks after the first-stage surgery.ConclusionsReimplantation must be carefully performed when the risk of reinfection is high, particularly in patients with more than three systemic or local comorbidities and higher inflammation indices (ESR and CRP) prior to revision TKA.

Risk of Reinfection after Irrigation and Debridement of Acute Periprosthetic Joint Infection following TKA

“…With primary PJI rates ! 1% and reinfection rates as high as 6.6 to 47% in some published articles, 21,22 PJI will continue to place a significant burden on the health care system along with increased patient morbidity and mortality. The Centers for Medicare and Medicaid have enacted strategies, such as the Bundled Payment for Care Improvement, to hold hospitals and providers accountable in the overall care episode of the patient which will place institutions and providers at a financial risk for complications and readmissions such as PJI.…”

“…risk of reinfection following the initial treatment of a primary TKA PJI ranges from 20 to 47%. 21,22,25 A majority of reinfections are seen within the first year of the first-line surgical treatment, but the incidence continues to increase with time. Two-stage revision is currently considered the gold standard for subacute and chronic PJIs.…”

Racial Disparities in Above-knee Amputations After TKA: A National Database Study

“…National arthroplasty registries in countries like the United Kingdom, Canada, and Australia allow the monitoring of outcomes of various procedures at a national level [1,9]. However, as a result of the lack of such a national joint registry, an administrative database like NIS was used for estimating the national trends, in line with other investigators [3,15]. Although NIS is the largest available national database, it is not without limitations.…”

Extended Oral Antibiotics and Infection Prophylaxis after a Primary or Revision Total Knee Arthroplasty

“…9 Additionally, certain medical comorbidities including obesity and diabetes mellitus have been shown to increase the risk of PJI due to the immunosuppressive effects on the host. 10 Therefore, significant research has focused on optimizing the patient's inflammatory state [10][11][12] prior to a staged exchange revision surgery to treat PJI. With the mortality risk three times greater in individuals who have a PJI after a TKA compared with the average individual, 13 there is a need to find a strategy that effectively controls the infections, which oftentimes includes antibiotics.…”