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Published on: December 3, 2017
Sobering Outcomes after Two-Stage Revision for Periprosthetic Joint Infection Among Patients Who Have Revision Total
Jacob R Ball1, Ryan C Palmer1, Sagar S Telang2
1Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California.
Introduction:
Periprosthetic joint infection (PJI) following revision total knee arthroplasty (TKA) is a major complication leading to substantial morbidity. Despite ongoing efforts, PJI remains the most common reason for failure following revision TKA. This study aimed to assess outcomes following the explantation of infected revision TKA components.
Methods:
A retrospective assessment was performed of patients treated with complete implant removal of a revision TKA construct for the diagnosis of PJI at a single tertiary academic center. Patient demographics, implants, intraoperative data, postoperative outcomes, and radiographic images were assessed. Revision components were defined as long stems, cones or sleeves, hinged components, or megaprosthetic components.
Results:
In total, 62 knees were evaluated with a mean follow-up of 3.4 ± 2.8 years. Construct features included long cemented stems in 44 (70.9%), hinged implants in 17 (27.4%), cones or sleeves in 15 (24.2%), and megaprosthetic components in 10 (16.1%). Mean operative time was 273.8 ± 91.5 minutes. Following explantation, 15 (24.2%) patients required intensive care unit admission, 16 (25.8%) required readmission within 90 days, 19 (30.6%) underwent unplanned reoperation, and 2 (3.2%) died within 1 year. Among the 48 (77.4%) replanted patients, 16 (33.3%) underwent subsequent reoperation, 9 (56.2%) for recurrent infection. At the last follow-up, 39 patients (62.9%) had re-revision implants in situ. There were seven patients (11.3%) who retained a static spacer, and 5 patients (8.1%) underwent above-knee amputation. Kaplan-Meier survivorship analysis demonstrated a 10-year survivorship estimate free from all-cause reoperation of 34.9% (95% Confidence Interval (CI): 17.2-71.0%) and survivorship free from reinfection of 63.9% (95% CI: 43.2-94.7%).
Conclusion:
The management of PJI following revision TKA is a challenging surgical problem that is associated with significant patient morbidity when resection arthroplasty and spacer placement are performed. When considering explantation of revision TKA components, surgeons and patients should be aware of the substantial risk of postoperative complications.
