Revision Total Knee Arthroplasty Infection: Incidence and Predictors
Tóm tắt
Deep infection remains one of the most devastating and costly complications after total knee arthroplasty (TKA). The risk of deep infection after revision TKA is reportedly greater than that for primary TKA; however, we do not know the exact incidence of infection after revision TKA. We determined the incidence of infection after revision, the type of microorganisms involved and TKA, and the potential risk factors for this infection. We retrospectively reviewed 475 patients (476 knees) with 499 TKA revisions performed between March 1998 and December 2005. Of the 476 knees, 91 (19%) were revised for infection and 385 (81%) were revised for aseptic failure. Preoperative history, results of physical examinations, laboratory and radiographic results, joint fluid aspiration results along with analysis of intraoperative findings were all considered to make an assessment of septic versus aseptic failure modes. Patients were followed for a minimum of 25 months (mean, 65 months; range, 25–159 months). Deep infection developed in 44 of the 476 knees (9%). The infection rate was higher in patients undergoing revision for infection than in patients with aseptic revisions: 21% (23 of 91) and 5% (21 of 385), respectively. Revision for infection, higher Charlson index, and diagnosis other than osteoarthritis at the time of primary TKA predicted infection of the revision. The risk of infection for patients undergoing TKA revisions was 10-fold higher than for patients undergoing primary TKA at our institution. Infection of primary TKA is the most important risk factor for subsequent infection of TKA revisions. Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
Tài liệu tham khảo
Babkin Y, Raveh D, Lifschitz M, Itzchaki M, Wiener-Well Y, Kopuit P, Jerassy Z, Yinnon AM. Incidence and risk factors for surgical infection after total knee replacement. Scand J Infect Dis. 2007;39;10:890–895.
Berbari EF, Hanssen AD, Duffy MC, Steckelberg JM, Ilstrup DM, Harmsen WS, Osmon DR. Risk factors for prosthetic joint infection: case-control study. Clin Infect Dis. 1998;27:1247–1254.
Birmingham P, Helm JM, Manner PA, Tuan RS. Simulated joint infection assessment by rapid detection of live bacteria with real-time reverse transcription polymerase chain reaction. J Bone Joint Surg Am. 2008;90:602–608.
Blom AW, Brown J, Taylor AH, Pattison G, Whitehouse S, Bannister GC. Infection after total knee arthroplasty. J Bone Joint Surg Br. 2004;86;5:688–691.
Bongartz T, Halligan CS, Osmon DR, Reinalda MS, Bamlet WR, Crowson CS, Hanssen AD, Matteson EL. Incidence and risk factors of prosthetic joint infection after total hip or knee replacement in patients with rheumatoid arthritis. Arthritis Rheum. 2008;59:1713–1720.
Bradbury T, Fehring T, Taunton M, Hanssen A, Azzam K, Parvizi J, Odum S. The fate of acute MRSA periprosthetic knee infections treated by open débridement and retention of components. J Arthroplasty. 2009;24(Suppl):101–104.
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–383.
Dowsey MM, Choong PF. Obese diabetic patients are at substantial risk for deep infection after primary TKA. Clin Orthop Relat Res. 2009;467;6:1577–1581.
Dripps RD. New classification of physical status. Anesthesiology. 1963;24:111.
Fehring TK, Griffin WL. Revision of failed cementless total knee implants with cement. Clin Orthop Relat Res. 1998;356:34–38.
Friedman RJ, Hirst P, Poss R, Kelley K, Sledge CB. Results of revision total knee arthroplasty performed for aseptic loosening. Clin Orthop Relat Res. 1990;255:235–241.
Garvin KL, Cordero GX. Infected total knee arthroplasty: diagnosis and treatment. Instr Course Lect. 2008;57:305–315.
Goldberg VM, Figgie MP, Figgie HE III, Sobel M. The results of revision total knee arthroplasty. Clin Orthop Relat Res. 1988;226:86–92.
Jacobs MA, Hungerford DS, Krackow KA, Lennox DW. Revision total knee arthroplasty for aseptic failure. Clin Orthop Relat Res. 1988;226:78–85.
Jamsen E, Huhtala H, Puolakka T, Moilanen T. Risk factors for infection after knee arthroplasty. A register-based analysis of 43,149 cases. J Bone Joint Surg Am. 2009;91;1:38–47.
Johnson DP, Bannister GC. The outcome of infected arthroplasty of the knee. J Bone Joint Surg Br. 1986;68:289–291.
Kilgus DJ, Howe DJ, Strang A. Results of periprosthetic hip and knee infections caused by resistant bacteria. Clin Orthop Relat Res. 2002;404:116–124.
Kurtz SM, Lau E, Schmier J, Ong KL, Zhao K, Parvizi J. Infection burden for hip and knee arthroplasty in the United States. J Arthroplasty. 2008;23:984–991.
Lidwell OM. Clean air at operation and subsequent sepsis in the joint. Clin Orthop Relat Res. 1986;211:91–102.
Mauerhan DR, Nelson CL, Smith DL, Fitzgerald RH Jr, Slama TG, Petty RW, Jones RE, Evans RP. Prophylaxis against infection in total joint arthroplasty. One day of cefuroxime compared with three days of cefazolin. J Bone Joint Surg Am. 1994;76:39–45.
Minnema B, Vearncombe M, Augustin A, Gollish J, Simor AE. Risk factors for surgical-site infection following primary total knee arthroplasty. Infect Control Hosp Epidemiol. 2004;25:477–480.
Mont MA, Waldman BJ, Hungerford DS. Evaluation of preoperative cultures before second-stage reimplantation of a total knee prosthesis complicated by infection. A comparison-group study. J Bone Joint Surg Am. 2000;82:1552–1557.
Peersman G, Laskin R, Davis J, Peterson M. Infection in total knee replacement: a retrospective review of 6489 total knee replacements. Clin Orthop Relat Res. 2001;392:15–23.
Peersman G, Laskin R, Davis J, Peterson MG, Richart T. Prolonged operative time correlates with increased infection rate after total knee arthroplasty. HSS J. 2006;2:70–72.
Peters CL, Hennessey R, Barden RM, Galante JO, Rosenberg AG. Revision total knee arthroplasty with a cemented posterior-stabilized or constrained condylar prosthesis: a minimum 3-year and average 5-year follow-up study. J Arthroplasty. 1997;12:896–903.
Phillips JE, Crane TP, Noy M, Elliott TS, Grimer RJ. The incidence of deep prosthetic infections in a specialist orthopaedic hospital: a 15-year prospective survey. J Bone Joint Surg Br. 2006;88:943–948.
Poss R, Thornhill TS, Ewald FC, Thomas WH, Batte NJ, Sledge CB. Factors influencing the incidence and outcome of infection following total joint arthroplasty. Clin Orthop Relat Res. 1984;182:117–126.
Pulido L, Ghanem E, Joshi A, Purtill JJ, Parvizi J. Periprosthetic joint infection: the incidence, timing, and predisposing factors. Clin Orthop Relat Res. 2008;466:1710–1715.
Rand JA, Bryan RS. Results of revision total knee arthroplasties using condylar prostheses. A review of fifty knees. J Bone Joint Surg Am. 1988;70:738–745.
Saleh K, Olson M, Resig S, Bershadsky B, Kuskowski M, Gioe T, Robinson H, Schmidt R, McElfresh E. Predictors of wound infection in hip and knee joint replacement: results from a 20 year surveillance program. J Orthop Res. 2002;20:506–515.
Salgado CD, Dash S, Cantey JR, Marculescu CE. Higher risk of failure of methicillin-resistant Staphylococcus aureus prosthetic joint infections. Clin Orthop Relat Res. 2007;461:48–53.
Sculco TP. The economic impact of infected joint arthroplasty. Orthopedics. 1995;18:871–873.
Segawa H, Tsukayama DT, Kyle RF, Becker DA, Gustilo RB. Infection after total knee arthroplasty. A retrospective study of the treatment of eighty-one infections. J Bone Joint Surg Am. 1999;81:1434–1445.
Sheng PY, Jamsen E, Lehto M, Pajamaki J, Halonen P, Konttinen YT. Revision total knee arthroplasty with the total condylar III system: a comparative analysis of 71 consecutive cases of osteoarthritis or inflammatory arthritis. Acta Orthop. 2006;77:512–518.
Sierra RJ, Cooney WP, Pagnano MW, Trousdale RT, Rand JA. Reoperations after 3200 revision TKAs: rates, etiology, and lessons learned. Clin Orthop Relat Res. 2004;425:200–206.
Smith RC, Mooar PA, Cooke T, Sherk HH. Contamination of operating room personnel during total arthroplasty. Clin Orthop Relat Res. 1991;271:9–11.
Stuart MJ, Larson JE, Morrey BF. Reoperation after condylar revision total knee arthroplasty. Clin Orthop Relat Res. 1993;286:168–173.
Suarez J, Griffin W, Springer B, Fehring T, Mason JB, Odum S. Why do revision knee arthroplasties fail? J Arthroplasty. 2008;23(Suppl 1):99–103.
Trampuz A, Piper KE, Jacobson MJ, Hanssen AD, Unni KK, Osmon DR, Mandrekar JN, Cockerill FR, Steckelberg JM, Greenleaf JF, Patel R. Sonication of removed hip and knee prostheses for diagnosis of infection. N Engl J Med. 2007;357:654–663.
Wilson MG, Kelley K, Thornhill TS. Infection as a complication of total knee-replacement arthroplasty. Risk factors and treatment in sixty-seven cases. J Bone Joint Surg Am. 1990;72:878–883.
Wymenga AB, van Horn JR, Theeuwes A, Muytjens HL, Slooff TJ. Perioperative factors associated with septic arthritis after arthroplasty. Prospective multicenter study of 362 knee and 2,651 hip operations. Acta Orthop Scand. 1992;63:665–671.