Journal Article

Periprosthetic Joint Infection Is the Main Cause of Failure for Modern Knee Arthroplasty: An Analysis of 11,134 Knees

Ravi, Saiprassad, Zeng, Irene, Koh, Chuan Kong, Young, Simon W., Zhu, Mark, Vince, Kelly G.

2017

Overview

Background Although large series from national joint registries may accurately reflect indications for revision TKAs, they may lack the granularity to detect the true incidence and relative importance of such indications, especially periprosthetic joint infections (PJI). Questions/purposes Using a combination of individual chart review supplemented with New Zealand Joint Registry data, we asked: (1) What is the cumulative incidence of revision TKA? (2) What are the common indications for revising a contemporary primary TKA? (3) Do revision TKA indications differ at various followup times after primary TKA? Methods We identified 11,134 primary TKAs performed between 2000 and 2015 in three tertiary referral hospitals. The New Zealand Joint Registry and individual patient chart review were used to identify 357 patients undergoing subsequent revision surgery or any reoperation for PJI. All clinical records, radiographs, and laboratory results were reviewed to identify the primary revision reason. The cumulative incidence of each revision reason was calculated using a competing risk estimator. Results The cumulative incidence for revision TKA at 15 years followup was 6.1% (95% CI, 5.1%–7.1%). The two most-common revision reasons at 15 years followup were PJI followed by aseptic loosening. The risk of revision or reoperation for PJI was 2.0% (95% CI, 1.7%–2.3%) and aseptic loosening was 1.2% (95% CI, 0.7%–1.6%). Approximately half of the revision TKAs secondary to PJI occurred within 2 years of the index TKA (95% CI, 0.8%–1.2%), whereas half of the revision TKAs secondary to aseptic loosening occurred 8 years after the index TKA (95% CI, 0.4%–0.7%). Conclusions In this large cohort of patients with comprehensive followup of revision procedures, PJI was the dominant reason for failure during the first 15 years after primary TKA. Aseptic loosening became more important with longer followup. Efforts to improve outcome after primary TKA should focus on these areas, particularly prevention of PJI. Level of Evidence Level III, therapeutic study.

• Publisher: Springer US,Lippincott Williams & Wilkins Ovid Technologies
• Subject: Aged / Arthritis, Infectious - epidemiology / Arthritis, Infectious - etiology / Arthritis, Infectious - surgery / Arthroplasty (knee) / Arthroplasty, Replacement, Knee - adverse effects / Arthroplasty, Replacement, Knee - statistics & numerical data / Bone implants / Clinical Research / Conservative Orthopedics / Female / Follow-Up Studies / Humans / Incidence / Infection / Joint diseases / Joint surgery / Knee / Knee Prosthesis - adverse effects / Male / Medicine / Medicine & Public Health / Middle Aged / New Zealand - epidemiology / Orthopedics / Prosthesis Failure - etiology / Prosthesis-Related Infections - epidemiology / Prosthesis-Related Infections - etiology / Prosthesis-Related Infections - surgery / Radiography / Registries / Reoperation - methods / Reoperation - statistics & numerical data / Retrospective Studies / Sports Medicine / Surgery / Surgical Orthopedics / Treatment Outcome