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Evaluation of time to reimplantation as a risk factor in two-stage revision with static spacers for periprosthetic knee joint infection

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Title: Evaluation of time to reimplantation as a risk factor in two-stage revision with static spacers for periprosthetic knee joint infection
Authors: Puetzler, Jan, Hofschneider, Marc, Gosheger, Georg, Theil, Christoph, Schulze, Martin, Schwarze, Jan, Koch, Raphael, Moellenbeck, Burkhard
Source: J Orthop Traumatol
Journal of Orthopaedics and Traumatology, Vol 25, Iss 1, Pp 1-11 (2024)
Publisher Information: Springer Science and Business Media LLC, 2024.
Publication Year: 2024
Subject Terms: THA, Reoperation, Prosthetic joint infection, Prosthesis-Related Infections, Knee Joint, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Humans, Arthroplasty, Replacement, Knee, Aged, Retrospective Studies, Orthopedic surgery, Arthritis, Infectious, TKA, 3. Good health, Treatment Outcome, C-Reactive Protein, Reinfection, Replantation, Two-stage exchange revision arthroplasty, Original Article, Female, Knee Prosthesis, RD701-811, Prosthesis-Related Infections/etiology [MeSH], Female [MeSH], Reinfection/complications [MeSH], C-Reactive Protein [MeSH], Aged [MeSH], Humans [MeSH], Treatment Outcome [MeSH], Knee Joint/surgery [MeSH], Retrospective Studies [MeSH], Risk Factors [MeSH], Prosthesis-Related Infections/surgery [MeSH], Reoperation [MeSH], Arthroplasty, Replacement, Knee/adverse effects [MeSH], Knee Prosthesis/adverse effects [MeSH], Arthritis, Infectious/complications [MeSH], Replantation/adverse effects [MeSH]
Description: Introduction We investigated the time to reimplantation (TTR) during two-stage revision using static spacers with regard to treatment success and function in patients with chronic periprosthetic joint infection (PJI) of the knee. Methods 163 patients (median age 72 years, 72 women) who underwent two-stage exchange for chronic knee PJI between 2012 and 2020 were retrospectively analyzed (based on the 2011 Musculoskeletal Infection Society criteria). A cutoff TTR for increased risk of reinfection was identified using the maximally selected log-rank statistic. Infection control, aseptic revisions and overall survival were analyzed using Kaplan–Meier survival estimates. Adjustment for confounding factors—the Charlson Comorbidity Index (CCI) and C-reactive protein (CRP)—was done with a Cox proportional hazards model. Results When TTR exceeded 94 days, the adjusted hazard of reinfection was increased 2.8-fold (95% CI 1.4–5.7; p = 0.0036). The reinfection-free rate was 67% (95% CI 52-79%) after 2 years and 33% (95% CI 11–57%) after 5 years for a longer TTR compared to 89% (95% CI 81–94%) and 80% (95% CI 69–87%) at 2 and 5 years, respectively, for a shorter TTR. Adjusted overall survival and number of aseptic revisions did not differ between the longer TTR and shorter TTR groups. Maximum knee flexion was 90° (IQR 84–100) for a longer TTR and 95° (IQR 90–100) for a shorter TTR (p = 0.0431), with no difference between the groups in Oxford Knee Score. Baseline characteristics were similar (body mass index, age, previous surgeries, microorganisms) for the two groups, except that there was a higher CCI (median 4 vs. 3) and higher CRP (median 3.7 vs 2.6 mg/dl) in the longer TTR group. Conclusion A long TTR is sometimes unavoidable in clinical practice, but surgeons should be aware of a potentially higher risk of reinfection. Level of evidence: III, retrospective comparative study.
Document Type: Article
Other literature type
Language: English
ISSN: 1590-9999
DOI: 10.1186/s10195-024-00745-7
Access URL: https://pubmed.ncbi.nlm.nih.gov/38528169
https://doaj.org/article/bee6673d8fb043f29c7fcdd763a21f22
https://repository.publisso.de/resource/frl:6518775
Rights: CC BY
Accession Number: edsair.doi.dedup.....cfb92b9f540465c85afa01f1b5d64a6d
Database: OpenAIRE
Description
Abstract:Introduction We investigated the time to reimplantation (TTR) during two-stage revision using static spacers with regard to treatment success and function in patients with chronic periprosthetic joint infection (PJI) of the knee. Methods 163 patients (median age 72 years, 72 women) who underwent two-stage exchange for chronic knee PJI between 2012 and 2020 were retrospectively analyzed (based on the 2011 Musculoskeletal Infection Society criteria). A cutoff TTR for increased risk of reinfection was identified using the maximally selected log-rank statistic. Infection control, aseptic revisions and overall survival were analyzed using Kaplan–Meier survival estimates. Adjustment for confounding factors—the Charlson Comorbidity Index (CCI) and C-reactive protein (CRP)—was done with a Cox proportional hazards model. Results When TTR exceeded 94 days, the adjusted hazard of reinfection was increased 2.8-fold (95% CI 1.4–5.7; p = 0.0036). The reinfection-free rate was 67% (95% CI 52-79%) after 2 years and 33% (95% CI 11–57%) after 5 years for a longer TTR compared to 89% (95% CI 81–94%) and 80% (95% CI 69–87%) at 2 and 5 years, respectively, for a shorter TTR. Adjusted overall survival and number of aseptic revisions did not differ between the longer TTR and shorter TTR groups. Maximum knee flexion was 90° (IQR 84–100) for a longer TTR and 95° (IQR 90–100) for a shorter TTR (p = 0.0431), with no difference between the groups in Oxford Knee Score. Baseline characteristics were similar (body mass index, age, previous surgeries, microorganisms) for the two groups, except that there was a higher CCI (median 4 vs. 3) and higher CRP (median 3.7 vs 2.6 mg/dl) in the longer TTR group. Conclusion A long TTR is sometimes unavoidable in clinical practice, but surgeons should be aware of a potentially higher risk of reinfection. Level of evidence: III, retrospective comparative study.
ISSN:15909999
DOI:10.1186/s10195-024-00745-7