Complications - InfectionTrends and Outcomes in the Treatment of Failed Septic Total Knee Arthroplasty: Comparing Arthrodesis and Above-Knee Amputation
Section snippets
Materials and Methods
All data for this study were retrieved from the PearlDiver Patient Records Database (www.pearldiverinc.com; PearlDiver Inc, Fort Wayne, IN), a publicly available, for-fee database of patients. The database contains demographics, procedure volumes, and average charge and reimbursement information for patients with International Classification of Diseases, 9th Revision (ICD-9) diagnoses and procedures or Current Procedural Terminology (CPT) codes. Data for the present study were derived from a
Results
A total of 7635 patients were identified in the database search over the 8-year study period from 2005 to 2012. A total of 2634 patients underwent a knee arthrodesis and 5001 patients underwent an AKA for septic TKA. The percentage of total patients who underwent AKA increased significantly throughout the study period compared to knee arthrodesis (P < .0001; Fig. 1).
A larger percentage of patients in the AKA group were above the age of 80 (24.9%) compared to the arthrodesis group (16.2%). The
Discussion
Deep periprosthetic infection remains a particularly devastating complication after TKA. Although 2-stage revision protocols have a high success rate, a percentage of infections cannot be eradicated and reimplantation of components is not possible. In these situations, the surgeon must often choose between a knee arthrodesis or AKA to effectively eradicate the infection. In the studied population, AKA was performed more frequently than knee arthrodesis for septic failure of TKA from 2005 to
Conclusion
In the present study, AKA appears to be performed more frequently than knee arthrodesis for septic failure of TKA from 2005 to 2012. AKA was performed more frequently in older patients and in patients with a higher incidence of certain medical comorbidities. Arthrodesis for septic TKA is associated with significantly higher rates of postoperative infection and blood transfusion compared to AKA, whereas systemic complications and in-hospital mortality were more common after AKA. Arthrodesis had
References (35)
The infected total knee: management options
J Arthroplasty
(2005)- et al.
Limited success with open debridement and retention of components in the treatment of acute Staphylococcus aureus infections after total knee arthroplasty
J Arthroplasty
(2003) - et al.
Antibiotic-loaded articulating cement spacer in the 2-stage exchange of infected total knee arthroplasty
J Arthroplasty
(2004) Managing the infected knee: as good as it gets
J Arthroplasty
(2002)- et al.
Outcomes of infected revision knee arthroplasty managed by two-stage revision in a tertiary referral centre
Knee
(2015) - et al.
Factors influencing the outcome of deep infection following total knee arthroplasty
Knee
(2015) - et al.
Arthrodesis should be strongly considered after failed two-stage reimplantation TKA
Clin Orthop Relat Res
(2014) - et al.
Above knee amputation following total knee arthroplasty: when enough is enough
J Arthroplasty
(2015) - et al.
Two-stage revision total knee arthroplasty in cases of periprosthetic joint infection: an analysis of 50 cases
Open Orthop J
(2015) - et al.
Assessing the gold standard: a review of 253 two-stage revisions for infected TKA
Clin Orthop Relat Res
(2012)
Preoperative diagnosis of periprosthetic joint infection: role of aspiration
AJR Am J Roentgenol
Definition of periprosthetic joint infection: is there a consensus?
Clin Orthop Relat Res
Outcomes of revision total knee arthroplasty after methicillin-resistant Staphylococcus aureus infection
Clin Orthop Relat Res
Articulating versus static spacers in revision total knee arthroplasty for sepsis. The Ranawat Award
Clin Orthop Relat Res
2-stage reimplantation for infected total knee replacement
Clin Orthop Relat Res
Mid-term to long-term followup of two-stage reimplantation for infected total knee arthroplasty
Clin Orthop Relat Res
Patient outcome with reinfection following reimplantation for the infected total knee arthroplasty
Clin Orthop Relat Res
Cited by (35)
Recurrent Periprosthetic Joint Infections: Diagnosis, Management, and Outcomes
2024, Orthopedic Clinics of North AmericaKnee arthrodesis using a compression clamp and a single-plane external fixator to treat infection
2022, Orthopaedics and Traumatology: Surgery and ResearchKnee arthrodesis using a compression clamp and a single-plane external fixator to treat infection
2022, Revue de Chirurgie Orthopedique et TraumatologiqueOsseointegration Following Transfemoral Amputation After Infected Total Knee Replacement: A Case Series of 10 Patients With a Mean Follow-up of 5 Years
2022, Arthroplasty TodayCitation Excerpt :KF may be viewed as favorable because patients retain the potential for bipedal ambulation without a prosthetic leg. However, QOL may not be superior [33,34]; 5.9% of patients may remain infected, 14.6% may lose ambulatory capacity, 18.8% of ambulatory patients may require assistive devices, and 50% of patients may have additional unplanned surgeries. Regarding TKR PJI amputees, only 25% may walk at 38.5 months following amputation [6], 55.9% primarily use a wheelchair for mobility, 79.5% have phantom pain, 47.1% require chronic pain medications, and only 52.9% were satisfied with their QOL [35].
Management of Periprosthetic Joint Infection and Extensor Mechanism Disruption With Modular Knee Fusion: Clinical and Biomechanical Outcomes
2021, Arthroplasty TodayCitation Excerpt :A second 2-stage protocol with extensor mechanism reconstruction necessitates prolonged immobilization and delayed ambulation [4,5], and a recent multicenter study demonstrated a 75% rate of failure, mostly from reinfection [1]. While AKA is an option, results are also not favorable with loss of mobility, prolonged hospital stays, and high readmission rates [6-8]. Hungerer et al. [2] found that no patients who underwent AKA over the age of 60 years were able walk with a prosthesis.
One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to http://dx.doi.org/10.1016/j.arth.2016.01.010.