CLINICAL OUTCOME AFTER INFECTED TOTAL KNEE AND TOTAL HIP ARTHROPLASTY.

Falk Mittag,Carmen Ina Leichtle,Michael Schlumberger,Ulf Gunther Leichtle,Markus Wünschel

doi:10.1590/1413-785220162401150767

Falk Mittag, Carmen Ina Leichtle + Show 3 more

Open Access

https://doi.org/10.1590/1413-785220162401150767

Copy DOI

Abstract

ABSTRACTObjective: Infection after total hip (THA) and knee arthroplasty (TKA) is a serious complication which typically leads to a long lasting and intensive surgical and medicamentous treatment. The aim of this study was to identify factors that influence outcome after revision surgery caused by prosthetic infection.Methods: We retrospectively analyzed 64 patients who had revision surgery between 1989 and 2009 due to periprosthetic infection. We examined a total of 69 joints (TKA: 36%, THA: 64%), follow-up 5.1 years (0.5-21 years) after the initial surgical intervention. The mean patient age at time of surgery was 67 years old (43-79 years old). Clinical data and scores including the Western Ontario and McMaster Universities (WOMAC)-Index, the Harris Hip Score (HHS) and the Hospital for Special Surgery Score (HSS) were surveyed. Results: There was no difference in clinical scores regarding treatment between a single and a multiple stage treatment regime. Infections with multiple microorganisms and Enterococcus spp. lead to a significantly higher number of interventions. Using a modified Tsukayama system we classified 24% as type I, 34% type II and 42% type III- infections, with no differences in clinical outcome. Overweight patients had a significantly lower HHS and WOMAC-score. Immunosuppression leads to a worse WOMAC and HSS-Score. An increased number of procedures was associated to a limping gait. Conclusion: Thorough surgical technique leads to good clinical results independent of infection-type and treatment philosophy. Level of Evidence III, Case Control Study.

Highlights

Infection rates after primary total knee arthroplasty (TKA) and total hip arthroplatsy (THA) are low[1], the numbers of revision arthroplasty caused by prosthetic infection is rising[2] due to a growing quantity of arthroplasties performed.[3]
We examined a total of 69 joints (TKA: 36%, THA: 64%) 5.1 years (0.5-21) after the first surgical intervention which consisted either of single- (23%) or multiple-stage treatment (77%)
All but 5 patients had revision arthroplasty (4 THA-patients had a permanent girdlestone-situation and 1 TKA-patient was treated with an arthrodesis of the knee joint, this was due to patient preference). 37% of the patients suffered from a potentially immunosuppressive disease like diabetes mellitus, rheumatoid arthritis or a neoplasm

Summary

Introduction

Infection rates after primary total knee arthroplasty (TKA) and total hip arthroplatsy (THA) are low[1], the numbers of revision arthroplasty caused by prosthetic infection is rising[2] due to a growing quantity of arthroplasties performed.[3]. The first step to initiate the right treatment is the correct diagnosis, which in this special entity is sometimes very difficult to achieve since there is no single evidentiary symptom, diagnostic test or imaging modality. Laboratory tests like C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR) have good sensitivity but lower specifity and are mainly useful when a number of tests at different dates can be compared and correlated to clinical symptoms. Native x-rays in combination with other image modalities like radionuclide scans are useful for the diagnosing process since magnetic resonance tomography and computed tomography may hardly be used due to artifacts caused by the implant.

Methods

Results

Discussion

Conclusion