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Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
Published on: December 3, 2017
Infection after total knee arthroplasty
A W Blom1, J Brown, A H Taylor
1Avon Orthopaedic Centre, Southmead Hospital, Westbury-on-Trim, Bristol, England.
Abstract:
The aim of our study was to determine the current incidence and outcome of infected total knee arthroplasty (TKA) in our unit comparing them with our earlier audit in 1986, which had revealed infection rates of 4.4% after 471 primary TKAs and 15% after 23 revision TKAs at a mean follow-up of 2.8 years. In the interim we introduced stringent antibiotic prophylaxis, and the routine use of occlusive clothing within vertical laminar flow theatres and 0.05% chlorhexidine lavage during arthroplasty surgery. We followed up 931 primary TKAs and 69 revision TKAs for a mean of 6.5 years (5 to 8). Patients were traced by postal questionnaire, telephone interview or examination of case notes of the deceased. Nine (1%) of the patients who underwent primary TKA, and four (5.8%) of those who underwent revision TKA developed deep infection. Two of nine patients (22.2%) who developed infection after primary TKA were successfully treated without further surgery. All four of the patients who had infection after revision TKA had a poor outcome with one amputation, one chronic discharging sinus and two arthrodeses. Patients who underwent an arthrodesis had comparable Oxford knee scores to those who underwent a two-stage revision. Although infection rates have declined with the introduction of prophylactic measures, and more patients are undergoing TKA, the outcome of infected TKA has improved very little.
Insights
Infection rates after total knee arthroplasty (TKA) have decreased due to new protocols. However, the outcomes for patients who develop deep infections after TKA have shown minimal improvement.
Area of Science:
- Orthopedic Surgery
- Infectious Disease Epidemiology
Background:
- Previous audit in 1986 reported high infection rates: 4.4% for primary and 15% for revision total knee arthroplasty (TKA).
- Implementation of enhanced prophylactic measures including antibiotic prophylaxis, sterile occlusive clothing, and chlorhexidine lavage.
- Significant increase in the volume of TKA procedures performed since the initial audit.
Purpose of the Study:
- To determine the current incidence and outcomes of infected total knee arthroplasty (TKA).
- To compare current infection rates and outcomes with a previous audit from 1986.
- To evaluate the impact of implemented prophylactic measures on TKA infection rates and patient outcomes.
Main Methods:
- Prospective follow-up of 931 primary and 69 revision TKAs.
- Patient tracing via postal questionnaire, telephone interview, and review of medical records.
- Data collection on deep infection development and treatment outcomes.
Main Results:
- Current deep infection rates are 1% for primary and 5.8% for revision TKA, a significant decrease from 1986.
- For primary TKA infections, 22.2% were treated successfully without further surgery.
- Outcomes for infected revision TKA were poor, including amputation, chronic discharging sinus, and arthrodesis, with comparable functional scores to two-stage revisions.
Conclusions:
- Stringent prophylactic measures have successfully reduced total knee arthroplasty (TKA) infection rates.
- Despite reduced infection incidence, the outcomes for patients experiencing infected TKA, particularly revision cases, remain challenging.
- Further strategies may be needed to improve the management and long-term outcomes of infected TKA.
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