scholarly journals Revision arthroplasty after unicompartimental knee arthroplasty

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Nike Walter ◽  
Johannes Weber ◽  
Maximilian Kerschbaum ◽  
Edmund Lau ◽  
Steven M. Kurtz ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Joint Infection ◽  
Treatment Strategies ◽  
Revision Arthroplasty ◽  
Younger Patients ◽  
Therapy Strategy ◽  
Primary Arthroplasty ◽  
Aseptic Revision ◽  
Unicompartimental Knee Arthroplasty ◽  
And Gender

Abstract Background Unicompartimental knee arthroplasty (UKA) is a promising and increasing application to treat unicompartimental knee osteoarthritis. However, revision arthroplasty numbers after UKA are unknown. Therefore, aim of this study was to determine the nationwide burden of revision after UKA by answering the following questions: (1) How did numbers of revision UKA procedures developed over the last decade as a function of age and gender? (2) How high is the percentage of revision UKA procedures due to infection? (3) Which therapy strategy was chosen for surgical treatment of aseptic revision UKA? Methods Revision arthroplasty rates as a function of age, gender, infection and type of prosthesis were quantified based on Operation and Procedure Classification System codes using revision knee arthroplasty data from 2008 to 2018, provided by the Federal Statistical Office of Germany (Destatis). Results Over the last decade, revision UKA increased by 46.3% up to 3105 procedures in 2018. A trend towards higher numbers in younger patients was observed. Septic interventions constituted 5.7% of all revisions, whereby total procedures increased by 67.1% from 2008 through 2018. The main treatment strategy was an exchange to a bicondylar surface replacement prosthesis, which was done in 63.70% of all cases, followed by exchange to a femoral and tibial shaft-anchored (16.2% of all revisions). Conclusion The increasing number of revision arthroplasty after UKA in Germany, especially in younger patients and due to infection, underlines the need for future efforts to improve treatment strategies beyond UKA to delay primary arthroplasty and avoid periprosthetic joint infection.

scholarly journals Recent trends in revision knee arthroplasty in Germany

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Markus Rupp ◽  
Nike Walter ◽  
Edmund Lau ◽  
Michael Worlicek ◽  
Steven M. Kurtz ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Knee Prosthesis ◽  
Joint Infection ◽  
Treatment Strategies ◽  
Revision Arthroplasty ◽  
Younger Patients ◽  
Revision Knee Arthroplasty ◽  
Primary Arthroplasty ◽  
Multi Stage ◽  
Procedure Classification

AbstractWe aimed to answer the following questions: (1) How did numbers of revision knee arthroplasty procedures develop in Germany over the last decade compared to primary TKA? (2) How high was the percentage of septic interventions in knee prosthesis revisions? (3) Which treatment strategy was chosen for surgical treatment of knee PJI? Revision arthroplasty rates as a function of age, gender, infection and type of prosthesis were quantified based on Operation and Procedure Classification System codes using revision knee arthroplasty data from 2008 to 2018, provided by the Federal Statistical Office of Germany (Destatis). In 2018, a total number 23,812 revision knee arthroplasties were performed in Germany, yielding an overall increase of 20.76% between 2008 and 2018. In comparison, primary TKA procedures increased by 23.8% from 152,551 performed procedures in 2008 to 188,866 procedures in 2018. Hence, 12.6% of knee arthroplasties required a revision in 2018. Septic interventions increased by 51.7% for all revisions. A trend towards higher numbers in younger patients was observed. Compared to 2008, 17.41% less DAIR procedures were performed, whereby single-stage and two- or multi-stage change increased by 38.76% and 42.76% in 2018, respectively. The increasing number of revision knee arthroplasty in Germany, especially in younger patients and due to infection, underlines the need for future efforts to improve treatment strategies to delay primary arthroplasty and avoid periprosthetic joint infection.

Development of antibiotic resistance in periprosthetic joint infection after total knee arthroplasty

2021 ◽  
Vol 103-B (6 Supple A) ◽  
pp. 171-176
Author(s):  
Antonio Klasan ◽  
Arne Schermuksnies ◽  
Florian Gerber ◽  
Matt Bowman ◽  
Susanne Fuchs-Winkelmann ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Antibiotic Resistance ◽  
Knee Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Revision Arthroplasty ◽  
Bacterial Strains ◽  
Coagulase Negative Staphylococci ◽  
Primary Arthroplasty ◽  
Total Knee

Aims The management of periprosthetic joint infection (PJI) after total knee arthroplasty (TKA) is challenging. The correct antibiotic management remains elusive due to differences in epidemiology and resistance between countries, and reports in the literature. Before the efficacy of surgical treatment is investigated, it is crucial to analyze the bacterial strains causing PJI, especially for patients in whom no organisms are grown. Methods A review of all revision TKAs which were undertaken between 2006 and 2018 in a tertiary referral centre was performed, including all those meeting the consensus criteria for PJI, in which organisms were identified. Using a cluster analysis, three chronological time periods were created. We then evaluated the antibiotic resistance of the identified bacteria between these three clusters and the effectiveness of our antibiotic regime. Results We identified 129 PJIs with 161 culture identified bacteria in 97 patients. Coagulase-negative staphylococci (CNS) were identified in 46.6% cultures, followed by Staphylococcus aureus in 19.8%. The overall resistance to antibiotics did not increase significantly during the study period (p = 0.454). However, CNS resistance to teicoplanin (p < 0.001), fosfomycin (p = 0.016), and tetracycline (p = 0.014) increased significantly. Vancomycin had an 84.4% overall sensitivity and 100% CNS sensitivity and was the most effective agent. Conclusion Although we were unable to show an overall increase in antibiotic resistance in organisms that cause PJI after TKA during the study period, this was not true for CNS. It is concerning that resistance of CNS to new antibiotics, but not vancomycin, has increased in a little more than a decade. Our findings suggest that referral centres should continuously monitor their bacteriological analyses, as these have significant implications for prophylactic treatment in both primary arthroplasty and revision arthroplasty for PJI. Cite this article: Bone Joint J 2021;103-B(6 Supple A):171–176.

scholarly journals Non-Hodgkin Lymphoma Mimics Infected Total Knee Arthroplasty

2018 ◽  
Vol 24 (1) ◽  
pp. 25-28
Author(s):  
Lo Chi-Kin ◽  
Lai Chun-Kit ◽  
Tsang Koon-Ho ◽  
Wong Yiu-Chung
Keyword(s):  
Total Knee Arthroplasty ◽  
Hodgkin Lymphoma ◽  
Knee Arthroplasty ◽  
Joint Infection ◽  
Revision Arthroplasty ◽  
B Cell Lymphoma ◽  
Pathology Report ◽  
Non Hodgkin Lymphoma ◽  
Infected Total Knee Arthroplasty ◽  
Total Knee

Lymphoma associated with total knee arthroplasty is a rare condition. We report a case of non-Hodgkin lymphoma mimicking an infected total knee arthroplasty. A 73-year-old woman who received left total knee replacement presented with fever and a discharging sinus over her left knee 12 weeks after surgery. The diagnosis of prosthetic joint infection was made and a two-stage revision arthroplasty planned. After implant removal and insertion of an antibiotic spacer in the first-stage operation, culture results of all intraoperative specimens were negative but the pathology report showed diffuse large B-cell lymphoma. She then received chemotherapy and a second-stage reconstruction operation. The wound healed uneventfully and she regained independent mobility.

scholarly journals The mildly decreased preoperative bilirubin level is a risk factor for periprosthetic joint infection after total hip and knee arthroplasty

Arthroplasty ◽  
2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Jun Fu ◽  
Xiyue Chen ◽  
Ming Ni ◽  
Xiang Li ◽  
Libo Hao ◽  
...  
Keyword(s):  
Risk Factor ◽  
Bilirubin Level ◽  
Knee Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Primary Arthroplasty ◽  
Significant Difference ◽  
Serologic Markers ◽  
Hip And Knee Arthroplasty ◽  
Laboratory Biomarkers

Abstract Background Many serologic markers are routinely tested prior to joint arthroplasty, but only few are commonly used to guide surgeons in determining patients most at risk of periprosthetic joint infection (PJI). The objective of this study was to investigate the association between preoperative bilirubin level and PJI after primary hip and knee arthroplasty. Methods A retrospective analysis was performed on patients undergoing revision hip and knee arthroplasty at our hospital from January 2016 to December 2019. Laboratory biomarkers were collected before the primary arthroplasty, as well as general patient information. The association between the above serologic markers and postoperative PJI was analyzed. Results A total of 72 patients (30 hips/42 knees) were analyzed, including 39 patients with PJI and 33 patients without PJI. Except for total bilirubin (TB) and direct bilirubin (DB), there was no significant difference between the remaining laboratory biomarkers. The preoperative TB and DB in the PJI group were 10.84 ± 0.61 μmol/L and 3.07 ± 0.19 μmol/L, respectively, which were lower than those in the non-PJI group (14.68 ± 0.75 μmol/L and 4.70 ± 0.39 μmol/L, P < 0.001). The area under the curve (AUC) of preoperative TB to predict PJI was 0.755 (P < 0.001, cutoff = 11.55 μmol/L, sensitivity = 66.67%, specificity = 75.76%). Meanwhile, the AUC of preoperative DB was 0.760 (P < 0.001, cutoff = 4.00 μmol/L, sensitivity = 84.62%, specificity = 54.45%). Conclusions The serum levels of TB and DB before the primary arthroplasty were lower in PJI patients than in non-PJI patients, and the preoperative values lower than 11.55 μmol/L and 4.00 μmol/L could be considered as a risk factor for postoperative PJI.

scholarly journals Variation of synovial fluid leucocyte cell count and polymorphonuclear percentage in patients with aseptic revision total knee arthroplasty

2021 ◽  
Vol 2 (8) ◽  
pp. 566-572
Author(s):  
Michael Fuchs ◽  
Felix Kirchhoff ◽  
Heiko Reichel ◽  
Carsten Perka ◽  
Martin Faschingbauer ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Synovial Fluid ◽  
Cell Count ◽  
Knee Arthroplasty ◽  
Revision Surgery ◽  
Joint Infection ◽  
Revision Total Knee Arthroplasty ◽  
Time Points ◽  
Aseptic Revision ◽  
Total Knee

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.

scholarly journals The serum level of D-Dimer is not suitable for distinguishing between prosthetic joint infection and aseptic loosening

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Jincheng Huang ◽  
Yongchao Zhang ◽  
Zhen Wang ◽  
Yonghui Dong ◽  
Yongqiang Zhao ◽  
...  
Keyword(s):  
Aseptic Loosening ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Revision Arthroplasty ◽  
Primary Arthroplasty ◽  
Prosthetic Joint ◽  
Group A ◽  
Group B ◽  
Serum Crp ◽  
D Dimer

Abstract Background To evaluate the meaning of serum CRP, ESR, and D-Dimer in the diagnosis of prosthetic joint infection. Methods In a retrospective study, 101 patients presented with osteoarthritis, PJI, and aseptic loosening were divided into three groups according to the type of operation they received in our department from June 2016 to December 2018: group A, 44 patients treated with primary arthroplasty; group B, 31 PJI patients treated with resection arthroplasty and spacer insertion surgery; group C, 26 aseptic loosening patients treated with revision arthroplasty. Data such as gender, age, preoperative serum CRP, ESR, and D-Dimer level were compared among the three different groups. Results There are no statistically significant differences when comparing general data such as gender and age in patients from the three different groups. However, Serum CRP level in group B (43.49 ± 10.00 mg/L) is significantly higher than in group A (2.97 ± 0.75 mg/L) and C (4.80 ± 1.26 mg/L). Serum ESR level in group B (49.84 ± 5.48 μg/L) is significantly higher than those in group A (15.28 ± 2.63 μg/L) and C (22.50 ± 3.47 μg/L). Serum D-Dimer level in group B (1.58 ± 0.17 μg/L) is significantly higher than that in group A (0.51 ± 0.50 μg/L), but similar with group C (1.22 ± 0.29 μg/L). There are no statistically significant differences when compared with sensitivity and specificity of CRP, ESR, and D-Dimer in the diagnosis of PJI among patients from the three different groups when D-Dimer > 0.85 μg/L was set as the optimal threshold value for the diagnosis of PJI. Conclusion D-Dimer is not a parameter to distinguish between aseptic loosening and PJI.

Poor Outcome of Above-Knee Amputation after Septic Failure of Revision Total Knee Arthroplasty

2020 ◽  
Author(s):  
Sabrina Böhle ◽  
Sebastian Rohe ◽  
Julia Kirschberg ◽  
Olaf Brinkmann ◽  
Jörn Seeger ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Joint ◽  
Knee Arthroplasty ◽  
Periprosthetic Infection ◽  
Short Form ◽  
Joint Infection ◽  
Treatment Strategies ◽  
Primary Total Knee Arthroplasty ◽  
Knee Amputation ◽  
Total Knee

AbstractPersistent periprosthetic infection following total knee arthroplasty is one of the most dreaded complications of orthopaedic surgery. Treatment strategies include arthrodesis of the knee joint, stable fistula, long-lasting antibiotic therapy, or above-knee amputation. The advantage of amputation in comparison to other treatment options is the possible cure of infection, because the source of infection is removed and no foreign material left in situ. The aim of the study is to examine whether a septic amputation of the femur in case of persistent periprosthetic infection at the knee joint leads to the healing of the patient. Moreover, the physical and mental state should be evaluated. All patients with above-knee amputation because of periprosthetic joint infection after primary total knee arthroplasty between 2016 and 2018 were included in this retrospective study. A questionnaire with the clinical scores visual analog scale, modified Lysholm, Western Ontario and McMaster Universities Osteoarthritis Index and 36-Item Short Form Survey has been designed. In addition, all characteristics and perioperative data were documented. Eleven patients were included in the study. One patient died after above-knee amputation; all other patients live with a marked impairment of quality of life but with absence of the infection of the leg. Two out of ten are able to walk regularly with an exoprosthesis with forearm crutches, 50% are in a wheelchair, while 30% are bedridden. Patients with above-knee amputation after persistent periprosthetic infections were free of infection and without signs of inflammation. However, this is associated with worse mobility and high mortality rate.

A Prolonged Post-Operative Antibiotic Regimen Reduced the Rate of Prosthetic Joint Infection after Aseptic Revision Knee Arthroplasty

2015 ◽  
Vol 16 (6) ◽  
pp. 775-780 ◽  
Author(s):  
Guillem Claret ◽  
Eduard Tornero ◽  
Juan-Carlos Martínez-Pastor ◽  
Mercè Piazuelo ◽  
Jésica Martínez ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Antibiotic Regimen ◽  
Revision Knee Arthroplasty ◽  
Prosthetic Joint ◽  
Aseptic Revision

scholarly journals The projected burden of complex surgical site infections following hip and knee arthroplasties in adults in the United States, 2020 through 2030

2018 ◽  
Vol 39 (10) ◽  
pp. 1189-1195 ◽  
Author(s):  
Hannah M. Wolford ◽  
Kelly M. Hatfield ◽  
Prabasaj Paul ◽  
Sarah H. Yi ◽  
Rachel B. Slayton
Keyword(s):  
Knee Arthroplasty ◽  
Revision Arthroplasty ◽  
Surgical Site Infections ◽  
Population Data ◽  
The United States ◽  
Prevention Measures ◽  
Primary Arthroplasty ◽  
The Us ◽  
Hip And Knee Arthroplasty ◽  
Total Burden

AbstractBackgroundAs the US population ages, the number of hip and knee arthroplasties is expected to increase. Because surgical site infections (SSIs) following these procedures contribute substantial morbidity, mortality, and costs, we projected SSIs expected to occur from 2020 through 2030.MethodsWe used a stochastic Poisson process to project the number of primary and revision arthroplasties and SSIs. Primary arthroplasty rates were calculated using annual estimates of hip and knee arthroplasty stratified by age and gender from the 2012–2014 Nationwide Inpatient Sample and standardized by census population data. Revision rates, dependent on time from primary procedure, were obtained from published literature and were uniformly applied for all ages and genders. Stratified complex SSI rates for arthroplasties were obtained from 2012–2015 National Healthcare Safety Network data. To evaluate the possible impact of prevention measures, we recalculated the projections with an SSI rate reduced by 30%, the national target established by the US Department of Health and Human Services (HHS).ResultsWithout a reduction in SSI rates, we projected an increase in complex SSIs following hip and knee arthroplasty of 14% between 2020 and 2030. We projected a total burden of 77,653 SSIs; however, meeting the 30% rate reduction could prevent 23,297 of these SSIs.ConclusionsGiven current SSI rates, we project that complex SSI burden for primary and revision arthroplasty may increase due to an aging population. Reducing the SSI rate to the national HHS target could prevent 23,000 SSIs and reduce subsequent morbidity, mortality, and Medicare costs.

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