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Anemia before reimplantation surgery - An overlooked modifiable risk factor of septic revision knee arthroplasty
Faustine Bredeche1, Isabelle Gounot1, Vincent Belgaïd2
1Département d'Anesthésie-Réanimation, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard, 69004 Lyon, France.
Introduction:
Preoperative anemia in patients undergoing a two-stage septic revision arthroplasty may be a factor of reinfection, even in the presence of aggressive antimicrobial therapy. Patient Blood Management (PBM) in such patients is challenging. We evaluate the impact of anemia existing before re-implantation on a failure rate after two-stage septic total knee arthroplasty (rTKA), and explore feasibility of a PBM strategy implementation in these patients.
Materials And Methods:
A retrospective study of patients from January 2010 to January 2015 in a French regional referral center was performed. Patients undergoing a two-stage rTKA for infection after successful primary TKA were identified and followed up to 31.12.2018. The primary outcome (failure) was defined as surgical site infection after re-implantation requiring new surgery. The secondary outcomes were time to failure, the time between explantation/reimplantation, transfusion rate during the second stage. Preoperative anemia was defined as Hb level < 12 g/L before the re-implantation.
Results:
69 patients were identified; 17 (24%) developed reinfection of rTKA in 105 [11.4-156] days. In these patients pre-implantation anemia was more frequent (n = 13(76.5%) in failed vs. n = 21(40%) in non-failed, p = 0.0110). During the explantation stage, there were no significant group differences in age, sex, comorbidity, type of spacer and antimicrobial therapy, iron supplementation, or transfusion rate. The median time between explantation/reimplantation surgery was 51 [43-71.5] days, indifferent between the two groups. Intraoperative transfusion during reimplantation was required in 12 (17%) patients, more frequent in failed patients. None of the patients had contraindications for the PBM strategy except the cell-saver use.
Conclusion:
In two-stage septic rTKA preoperative anemia was almost two times more frequent and associated with an elevated rate of septic failure. The time-frame between explantation and-re-implantation is sufficient to implement a PBM strategy for all anemic patients. Before-after studies would be of interest to determine the best PBM strategy to prevent anemia-associated septic failure in such a condition.
Insights
Preoperative anemia in patients undergoing two-stage septic revision knee arthroplasty is linked to a higher failure rate. Implementing a Patient Blood Management (PBM) strategy during the interval between surgeries is feasible and recommended.
Area of Science:
- Orthopedic Surgery
- Infectious Disease
- Hematology
Background:
- Preoperative anemia poses a challenge in two-stage septic revision total knee arthroplasty (rTKA), potentially increasing reinfection risk despite antimicrobial therapy.
- Patient Blood Management (PBM) strategies are difficult to implement in these complex cases.
- Evaluating the impact of preoperative anemia on failure rates and PBM feasibility in rTKA is crucial.
Purpose of the Study:
- To assess the association between preoperative anemia and failure rates in two-stage septic rTKA.
- To explore the feasibility of implementing a PBM strategy in patients undergoing two-stage septic rTKA.
Main Methods:
- A retrospective study identified patients who underwent two-stage septic rTKA between January 2010 and January 2015.
- Failure was defined as surgical site infection requiring reoperation after reimplantation.
- Preoperative anemia was defined as hemoglobin < 12 g/L before the second stage surgery.
Main Results:
- Of 69 patients, 17 (24%) experienced rTKA reinfection.
- Preoperative anemia was significantly more frequent in patients who failed (76.5%) compared to those who did not (40%).
- Intraoperative transfusions were more common in patients with failed rTKA.
Conclusions:
- Preoperative anemia is nearly twice as common in two-stage septic rTKA and is associated with increased septic failure rates.
- The interval between explantation and reimplantation is adequate for PBM strategy implementation in anemic patients.
- Further before-after studies are needed to determine optimal PBM strategies for preventing anemia-associated septic failure.
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