Abstract
BackgroundPeriprosthetic infection after total knee arthroplasty is a challenging problem, and physicians should identify risk factors to decrease recurrence. However, risk factors for reinfection with two-stage reimplantation have not yet been well established. The purpose of this study was to assess treatment outcomes of subsequent two-stage knee reimplantation and identify risk factors for uncontrolled periprosthetic knee joint infections.MethodsWe retrospectively reviewed 70 knees diagnosed with a periprosthetic knee joint infection treated with two-stage reimplantation between September 2011 and October 2016 at our institution. Patients in the controlled infection group (group C) required no further medication or surgical treatment within 2 years after reimplantation. Patients in the uncontrolled infection group (group U) displayed symptoms of active infection after resection arthroplasty or were reinfected after two-stage reimplantation. We compared group C and group U, and analyzed potential risk factors for uncontrolled prosthetic joint infection (PJI).ResultsOf 70 knees included in this analysis, 53 (75.7%) were clinically deemed free from infection at the latest follow-up. The remaining 17 knees (24.3%) required additional surgical procedures after two-stage reimplantation. Demographics were not statistically significantly different between the two groups. Wound complications were statistically more frequent in group U (p = 0.030). Pre-reimplantation C-reactive protein (CRP) was statistically different between groups C and U (0.44 and 1.70, respectively, p = 0.025). Among the cultured microorganisms, fungus species were statistically more frequently detected in group U compared with group C (p = 0.031).ConclusionsThe reinfection rate of our two-stage reimplantation protocol was 24.3% in the included cases. Wound complications, higher pre-reimplantation CRP levels, and fungus species were statistically more common in group U compared with group C. Our findings will help in counseling patients and physicians to understand that additional caution may be required when treating PJI if the aforementioned risk factors are present.Level of evidenceIV, case series.
Highlights
Periprosthetic infection after total knee arthroplasty is a challenging problem, and physicians should identify risk factors to decrease recurrence
We retrospectively reviewed 121 knees diagnosed with a Prosthetic joint infection (PJI) after total knee arthroplasty (TKA) between September 2011 and October 2016 at our institution
Proportional hazard regression univariate analysis was performed to assess the association of clinical covariates with the risk of Results Of the 70 knees included in this analysis, 67 were deemed clinically stable after resection arthroplasty; the remaining three required additional surgical treatment due to remaining infection and were classified as the first-stage failure group
Summary
Periprosthetic infection after total knee arthroplasty is a challenging problem, and physicians should identify risk factors to decrease recurrence. The purpose of this study was to assess treatment outcomes of subsequent twostage knee reimplantation and identify risk factors for uncontrolled periprosthetic knee joint infections. Remarkable outcomes have been achieved in many patients who underwent total knee arthroplasty (TKA), including improved quality of life [1]. Some patients treated with primary TKA do not achieve optimal outcomes, and total failure requiring revision arthroplasty may occur. Prosthetic joint infection (PJI) is one of the most common causes of TKA failure, occurring in approximately 2% of patients [2]. For patients with a chronic, peri-knee implant infection, two-stage reimplantation is preferred as this approach is associated with the highest chance to both eradicate the infection and provide patients with a functional and pain-free TKA [4]. Numerous two-stage reimplantation protocols have been reported and treatment results vary by surgeon [3, 5]
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