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Preoperative prediction of failure following two-stage revision for knee prosthetic joint infections
Fady Youssef Sabry1, Leonard Buller, Sarim Ahmed
1Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, Ohio.
Abstract:
While two-stage revision is the gold standard for treatment of knee prosthetic joint infection (PJI), it is not without risk. The purpose of this study was to develop a tool to preoperatively predict the probability that a two-stage revision would fail to eradicate knee PJI. 3,809 surgical cases were retrospectively reviewed and data were collected from 314 charts. Overall, 105 (33.4%) cases failed to eradicate PJI using this procedure. Univariate analysis identified multiple variables independently associated with reinfection. Logistic regression was used to generate a model (bootstrap-corrected concordance index of 0.773) predicting failure of infection eradication. Preoperative knowledge of a high probability of failure may improve risk assessment, lead to more aggressive management, and allow for time to consider alternative therapies.
Insights
Predicting knee prosthetic joint infection (PJI) treatment failure is crucial. This study developed a tool to assess the likelihood of two-stage revision failure, aiding in better patient risk assessment and alternative therapy considerations.
Area of Science:
- Orthopedic Surgery
- Infectious Disease
- Biostatistics
Background:
- Two-stage revision is the standard treatment for knee prosthetic joint infection (PJI).
- This procedure carries inherent risks and potential for treatment failure.
- Accurate preoperative risk assessment is essential for optimizing patient outcomes.
Purpose of the Study:
- To develop a predictive tool for preoperative assessment of two-stage revision failure in knee PJI.
- To identify key factors associated with treatment failure.
- To improve clinical decision-making and patient management strategies.
Main Methods:
- Retrospective review of 3,809 surgical cases.
- Data extraction from 314 patient charts.
- Logistic regression analysis to build a predictive model (concordance index: 0.773).
Main Results:
- The overall failure rate for eradicating knee PJI with two-stage revision was 33.4% (105 out of 314 cases).
- Univariate analysis identified several variables independently associated with reinfection.
- A logistic regression model was developed to predict failure of infection eradication.
Conclusions:
- A validated tool can predict the probability of two-stage revision failure in knee PJI.
- Preoperative prediction of failure can enhance risk stratification.
- This may facilitate more aggressive management and consideration of alternative treatment options.