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Published on: December 3, 2017
Risk of Reinfection After Treatment of Infected Total Knee Arthroplasty
Adam R Cochran1, Kevin L Ong2, Edmund Lau3
1Department of Orthopaedic Surgery, University of Louisville, Louisville, Kentucky.
Background:
The purpose of this study was to determine the incidence of subsequent reinfections after initial treatment of an infected total knee arthroplasty, identify risk factors leading to reinfection, and compare results among the varying treatment modalities.
Methods:
A total of 1,493,924 primary TKA patients were identified from the Medicare data between October 1, 2005, and December 31, 2011. Patients who encountered periprosthetic joint infection (PJI) after TKA were identified using International Classification of Diseases, Ninth Revision, Clinical Modification code 996.66. The risk of subsequent PJI was stratified based on the first-line treatment and compared between the various first-line treatment groups.
Results:
A total of 16,622 patients (1.1%) were diagnosed with PJI. The Kaplan-Meier risk of PJI was 0.77% at 1 year and 1.58% at 6 years. Age (P < .001), Charlson score (P < .001), hospital control (P < .001), race (P = .036), census region (P = .031), gender (P < .001) were identified as risk factors for PJI. Of the PJI patients, 20.8% (n = 2806) were treated with incision and drainage (I&D), 15.9% (n = 2150) treated with I&D and liner exchange, 22.7% (n = 3069) treated with 1-stage revision, 39.7% (n = 5364) treated with 2-stage revision, and 0.98% (n = 132) treated with amputation. After first-line treatment, 26% of patients with PJI had a subsequent PJI. Patients undergoing I&D as a first-line treatment had the highest risk of reinfection, with risks of 28.2% at 1 year and 43.2% at 6 years. One-stage revision patients had 33.9% greater adjusted risk of reinfection than 2-stage revision patients (P < .001).
Conclusion:
Two-stage reimplantation, despite 19% recurrence, had the highest success rate. Given the higher failure rates of I&D and single-stage revisions, guidelines need to be established for their specific indications.
Insights
Two-stage reimplantation offers the highest success rate for treating infected total knee arthroplasty (TKA), despite a 19% recurrence. Incision and drainage (I&D) and single-stage revisions show higher failure rates, necessitating clear treatment guidelines for TKA reinfection.
Area of Science:
- Orthopedic Surgery
- Infectious Disease
- Biostatistics
Background:
- Periprosthetic joint infection (PJI) is a significant complication following total knee arthroplasty (TKA).
- Understanding reinfection rates and risk factors is crucial for optimizing treatment strategies.
- Comparing the efficacy of different treatment modalities for PJI after TKA is essential.
Purpose of the Study:
- To determine the incidence of reinfection after initial treatment of infected TKA.
- To identify risk factors associated with TKA reinfection.
- To compare the outcomes of various treatment modalities for PJI.
Main Methods:
- Analysis of 1,493,924 primary TKA patients from Medicare data (2005-2011).
- Identification of PJI cases using ICD-9 code 996.66.
- Stratification of reinfection risk based on first-line treatment (e.g., incision and drainage, 1-stage vs. 2-stage revision).
Main Results:
- 16,622 patients (1.1%) developed PJI. Overall reinfection rate after first-line treatment was 26%.
- Risk factors for PJI included age, Charlson score, hospital control, race, census region, and gender.
- Incision and drainage (I&D) had the highest reinfection risk (28.2% at 1 year, 43.2% at 6 years). One-stage revision had a 33.9% higher adjusted risk of reinfection than two-stage revision.
Conclusions:
- Two-stage reimplantation demonstrated the highest success rate for treating PJI, with a 19% recurrence.
- Incision and drainage (I&D) and single-stage revision procedures exhibit higher failure rates.
- Establishment of clear guidelines for the indications of I&D and single-stage revisions is recommended.
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