Aseptic revision total knee arthroplasty outcomes were equivalent to patients’ own pre-failure state but inferior to patients without revision

Aims Current guidelines consider analyses of joint aspirates, including leucocyte cell count (LC) and polymorphonuclear percentage (PMN%) as a diagnostic mainstay of periprosthetic joint infection (PJI). It is unclear if these parameters are subject to a certain degree of variability over time. Therefore, the aim of this study was to evaluate the variation of LC and PMN% in patients with aseptic revision total knee arthroplasty (TKA). Methods We conducted a prospective, double-centre study of 40 patients with 40 knee joints. Patients underwent joint aspiration at two different time points with a maximum period of 120 days in between these interventions and without any events such as other joint aspirations or surgeries. The main indications for TKA revision surgery were aseptic implant loosening (n = 24) and joint instability (n = 11). Results Overall, 80 synovial fluid samples of 40 patients were analyzed. The average time period between the joint aspirations was 50 days (SD 32). There was a significantly higher percentage change in LC when compared to PMN% (44.1% (SD 28.6%) vs 27.3% (SD 23.7%); p = 0.003). When applying standard definition criteria, LC counts were found to skip back and forth between the two time points with exceeding the thresholds in up to 20% of cases, which was significantly more compared to PMN% for the European Bone and Joint Infection Society (EBJIS) criteria (p = 0.001), as well as for Musculoskeletal Infection Society (MSIS) (p = 0.029). Conclusion LC and PMN% are subject to considerable variation. According to its higher interindividual variance, LC evaluation might contribute to false-positive or false-negative results in PJI assessment. Single LC testing prior to TKA revision surgery seems to be insufficient to exclude PJI. On the basis of the obtained results, PMN% analyses overrule LC measurements with regard to a conclusive diagnostic algorithm. Cite this article: Bone Jt Open 2021;2(8):566–572.

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Patient-Reported Outcome Measures (Pain, Function, and Quality of Life) After Aseptic Revision Total Knee Arthroplasty

The Journal of Bone and Joint Surgery (American) ◽

10.2106/jbjs.19.01155 ◽

2020 ◽

Vol 102 (20) ◽

pp. e114

Author(s):

Nicolas S. Piuzzi ◽

Keyword(s):

Quality Of Life ◽

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Revision Total Knee Arthroplasty ◽

Patient Reported ◽

Aseptic Revision ◽

Total Knee

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Erratum: Patient-Reported Outcome Measures (Pain, Function, and Quality of Life) After Aseptic Revision Total Knee Arthroplasty

The Journal of Bone and Joint Surgery (American) ◽

10.2106/jbjs.er.19.01155 ◽

2020 ◽

Vol 102 (23) ◽

pp. e134

Keyword(s):

Quality Of Life ◽

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Revision Total Knee Arthroplasty ◽

Patient Reported ◽

Aseptic Revision ◽

Total Knee

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Rapid Recovery Is Feasible for Aseptic Revision Total Knee Arthroplasty at an Academic Medical Center

Arthroplasty Today ◽

10.1016/j.artd.2020.11.001 ◽

2021 ◽

Vol 7 ◽

pp. 109-113

Author(s):

Josef Pontasch ◽

Mario Sahlani ◽

Sumon Nandi

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Medical Center ◽

Academic Medical Center ◽

Revision Total Knee Arthroplasty ◽

Rapid Recovery ◽

Academic Medical ◽

Aseptic Revision ◽

Total Knee

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Total Knee Arthroplasty: The Efficacy of Calcium Sulfate Beads in One-Stage Aseptic Revision

10.31487/j.jsr.2019.01.05 ◽

2019 ◽

pp. 1-5

Author(s):

Ronald E. Delanois ◽

James Nace ◽

Joseph O. Ehiorobo

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Surgical Outcome ◽

Calcium Sulfate ◽

Joint Infection ◽

Revision Total Knee Arthroplasty ◽

One Stage ◽

Irrigation And Debridement ◽

Aseptic Revision ◽

Total Knee

Background: The risk of periprosthetic joint infection following revision total knee arthroplasty is high, as is the cost of care. Decreasing periprosthetic joint infection risk may include utilization of calcium sulfate beads. Calcium sulfate beads have been gaining momentum in treating infected joints because of their potential advantages, including antibiotic elution and dissolvability. However, literature documenting their utilization in aseptic revision is sparse. This study compares: 1) infection rates; 2) length of stay; 3) subsequent infection procedures; and 4) final surgical outcome between one-stage aseptic revision total knee arthroplasty patients who received calcium sulfate beads and those who did not. Methods: We performed a retrospective chart review to identify patients who underwent aseptic one-stage revision total knee arthroplasty between January 2013 and December 2017. Outcomes collected included postoperative infection rate, length of stay, subsequent irrigation and debridement, and final surgical outcome, classified as a successful total knee arthroplasty reimplantation, a retained antibiotic spacer, or an above knee amputation. Chi-square analysis was used to analyze all categorical variables, while Student’s t-testing was used for continuous variables. A p-value of 0.5 was set as the threshold for statistical significance. Results: Calcium sulfate bead patients did not differ from non-calcium sulfate bead patients with regard to the number of postoperative infections (p=0.103), lengths of stay (p=0.210), irrigation and debridement procedures (p=0.063) and surgical outcome (p=0.085). Conclusion: Patients who received calcium sulfate beads had analogous surgical outcomes and infection rates to non-calcium sulfate bead patients. The use of calcium sulfate beads in aseptic one-stage revision total knee arthroplasty may not be beneficial in preventing infection and reducing costs.

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