Low implantation volume, comorbidities, male sex and implantation of constrained TKA identified as risk factors for septic revision in knee arthroplasty: A register‐based study from the German Arthroplasty Registry

URN zum Zitieren dieses Dokuments:

urn:nbn:de:bvb:355-epub-583302 Copy

DOI zum Zitieren dieses Dokuments:

10.5283/epub.58330 Copy

Szymski, Dominik ; Walter, Nike ; Straub, Josina ; Wu, Yinan ; Melsheimer, Oliver ; Grimberg, Alexander ; Alt, Volker ; Steinbrueck, Arnd ; Rupp, Markus

Lizenz: Creative Commons Namensnennung 4.0 International PDF - Veröffentlichte Version (1MB)

Veröffentlichungsdatum dieses Volltextes: 24 Mai 2024 15:47

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Diese Publikation ist Teil des DEAL-Vertrags mit Wiley.

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Details

Dokumentenart:	Artikel
Open Access Art:	DEAL (Wiley)
Titel eines Journals oder einer Zeitschrift:	Knee Surgery, Sports Traumatology, Arthroscopy
Verlag:	Wiley
Datum:	17 April 2024
Institutionen:	Medizin > Lehrstuhl für Unfallchirurgie
Identifikationsnummer:	Wert Typ 10.1002/ksa.12182 DOI
Stichwörter / Keywords:	cemented, constrained, infection, knee, revision, unconstrained
Dewey-Dezimal-Klassifikation:	600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin
Status:	Veröffentlicht
Begutachtet:	Ja, diese Version wurde begutachtet
An der Universität Regensburg entstanden:	Ja
Dokumenten-ID:	58330

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Zusammenfassung

Abstract Purpose Periprosthetic joint infection (PJI) is a major cause of revision surgery after total knee arthroplasty (TKA) and unicondylar knee arthroplasty (UKA). Patient- and hospital-related risk factors need to be assessed to prevent PJI. This study identifies influential factors and differences in infection rates between different implant types. Methods Data were obtained from ...

Zusammenfassung

Abstract
Purpose

Periprosthetic joint infection (PJI) is a major cause of revision surgery after total knee arthroplasty (TKA) and unicondylar knee arthroplasty (UKA). Patient- and hospital-related risk factors need to be assessed to prevent PJI. This study identifies influential factors and differences in infection rates between different implant types.
Methods

Data were obtained from the German Arthroplasty Registry. Septic revisions were calculated using Kaplan–Meier estimates with septic revision surgery as the primary endpoint. Patients with constrained and unconstrained TKA or UKA were analysed using Holm's multiple log-rank test and Cox's proportional hazards ratio. The 300,998 cases of knee arthroplasty analysed included 254,144 (84.4%) unconstrained TKA, 9993 (3.3%) constrained TKA and 36,861 (12.3%) UKA with a maximum follow-up of 7 years.
Results

At 1 year, the PJI rate was 0.5% for UKA and 2.8% for TKA, whereas at 7 years, the PJI rate was 4.5% for UKA and 0.9% for TKA (p < 0.0001). The PJI rate significantly increased for constrained TKA compared to unconstrained TKA (p < 0.0001). The PJI rate was 2.0% for constrained TKA and 0.8% for unconstrained TKA at 1 year and 3.1% and 1.4% at 7 years. Implantation of a constrained TKA (hazard ratio [HR] = 2.55), male sex (HR = 1.84), increased Elixhauser score (HR = 1.18–1.56) and implant volume of less than 25 UKA per year (HR = 2.15) were identified as risk factors for revision surgery; an Elixhauser score of 0 (HR = 0.80) was found to be a preventive factor.
Conclusions

Reduced implant volume and constrained knee arthroplasty are associated with a higher risk of PJI. Comorbidities (elevated Elixhauser score), male sex and low UKA implant volume have been identified as risk factors for PJI. Patients who meet these criteria require specific measures to prevent infection. Further research is required on the potential impact of prevention and risk factor modification.
Level of Evidence

Level III.

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