scholarly journals Revision for periprosthetic joint infection rate stratified by seasonality of operation in a national population of total and unicompartmental knee arthroplasty patients: a register-based analysis

2021 ◽  
Vol 6 (5) ◽  
pp. 111-117
Author(s):  
Julius Tetens Hald ◽  
Anne Brun Hesselvig ◽  
Andreas Kryger Jensen ◽  
Anders Odgaard
Keyword(s):  
Logistic Regression ◽  
Seasonal Variation ◽  
Knee Arthroplasty ◽  
Seasonal Pattern ◽  
Joint Infection ◽  
Spline Regression ◽  
National Population ◽  
Primary Surgery ◽  
Increased Risk ◽  
Primary Procedure

Abstract. Aim: The aim of this study was to investigate whether the revision rate for periprosthetic joint infection (PJI) depends on the season of the primary procedure using a national population of knee arthroplasty (KA) patients. Seasonal variation of some surgical procedures has been observed to impact subsequent infection risks, with a higher risk of revision for surgeries performed during summer, but an analysis of PJI rates based on a national arthroplasty register has yet to be completed. We hypothesized that an increased risk of revision due to PJI could be demonstrated in a national population when primary surgery was performed during the summer. Methods: The Danish Knee Arthroplasty Registry (DKR) was used to determine the risk of revision due to PJI within 2 years after primary surgery. All primary KA procedures between 1 January 1997 and 31 December 2014 and revisions until 31 December 2016 were identified. Smoothing spline regression was used to identify possible seasonal pattern effects of the primary procedure on revision risk, and logistic regression was used to calculate risk of infection differences between seasons. Results: A total number of 124 809 primary procedures was registered in the study period. After excluding duplicates and matching primary procedures with the first revisions within 2 years after the primary procedure, 3391 were identified. Of these, 348 cases were recorded with an indication of deep infection requiring revision. Spline regression analyses did not demonstrate any clear seasonal pattern of the primary procedure regarding the risk of revision for infection or any other cause. Logistic regression found a decreased risk of revision for infection when the primary procedure was performed during the summer in the years 1997 to 2005, no influence on the risk of revision for infection in 2005 to 2012, and an increased risk of revision for infection following summer procedures during the years 2013 to 2014. Conclusion: It was not possible to demonstrate a consistent seasonal variation of the risk of revision for PJI following primary KA. This is most likely because the underlying etiologies for PJI are not subject to seasonal variation.

Increased risk of periprosthetic joint infection after acute, traumatic wound dehiscence following primary total knee arthroplasty

2021 ◽  
Vol 103-B (6 Supple A) ◽  
pp. 191-195
Author(s):  
Elizabeth B. Gausden ◽  
Matthew B. Shirley ◽  
Matthew P. Abdel ◽  
Rafael J. Sierra
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Significant Risk ◽  
Wound Dehiscence ◽  
Increased Risk ◽  
Primary Tkas ◽  
Traumatic Wound ◽  
Total Knee

Aims To describe the risk of periprosthetic joint infection (PJI) and reoperation in patients who have an acute, traumatic wound dehiscence following total knee arthroplasty (TKA). Methods From January 2002 to December 2018, 16,134 primary TKAs were performed at a single institution. A total of 26 patients (0.1%) had a traumatic wound dehiscence within the first 30 days. Mean age was 68 years (44 to 87), 38% (n = 10) were female, and mean BMI was 34 kg/m2 (23 to 48). Median time to dehiscence was 13 days (interquartile range (IQR) 4 to 15). The dehiscence resulted from a fall in 22 patients and sudden flexion after staple removal in four. The arthrotomy was also disrupted in 58% (n = 15), including a complete extensor mechanism disruption in four knees. An irrigation and debridement with component retention (IDCR) was performed within 48 hours in 19 of 26 knees and two-thirds were discharged on antibiotic therapy. The mean follow-up was six years (2 to 15). The association of wound dehiscence and the risk of developing a PJI was analyzed. Results Patients who sustained a traumatic wound dehiscence had a 6.5-fold increase in the risk of PJI (95% confidence interval (CI) 1.6 to 26.2; p = 0.008). With the small number of PJIs, no variables were found to be significant risk factors. However, there were no PJIs in any of the patients who were treated with IDCR and a course of antibiotics. Three knees required reoperation including one two-stage exchange for PJI, one repeat IDCR for PJI, and one revision for aseptic loosening of the tibial component. Conclusion Despite having a traumatic wound dehiscence, the risk of PJI was low, but much higher than experienced in all other TKAs during the same period. We recommend urgent IDCR and a course of postoperative antibiotics to decrease the risk of PJI. A traumatic wound dehiscence increases risk of PJI by 6.5-fold. Cite this article: Bone Joint J 2021;103-B(6 Supple A):191–195.

scholarly journals Timing of debridement, antibiotics, and implant retention (DAIR) for early post-surgical hip and knee prosthetic joint infection (PJI) does not affect 1-year re-revision rates: data from the Dutch Arthroplasty Register

2021 ◽  
Vol 6 (8) ◽  
pp. 329-336
Author(s):  
Barry van der Ende ◽  
Jakob van Oldenrijk ◽  
Max Reijman ◽  
Peter D. Croughs ◽  
Liza N. van Steenbergen ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Joint Infection ◽  
Successful Outcome ◽  
Optimal Timing ◽  
Arthroplasty Register ◽  
Total Hip ◽  
Prosthetic Joint ◽  
Significant Difference ◽  
Primary Procedure ◽  
Implant Retention

Abstract. Debridement, antibiotics, and implant retention (DAIR) is a procedure to treat a periprosthetic joint infection (PJI) after total hip arthroplasty (THA) or total knee arthroplasty (TKA). The timing between the primary procedure and the DAIR is likely a determinant for its successful outcome. However, the optimal timing of a DAIR and the chance of success still remain unclear. We aimed to assess the risk of re-revision within 1 year after a DAIR procedure and to evaluate the timing of the DAIR in primary THA and TKA. We used data from the Dutch Arthroplasty Register (LROI) and selected all primary THA and TKA in the period 2007–2016 which underwent a DAIR within 12 weeks after primary procedure. A DAIR was defined as a revision for infection in which only modular parts were exchanged. A DAIR was defined as successful if not followed by a re-revision within 1 year after DAIR; 207 DAIRs were performed <4 weeks after THA, of which 16 (8 %) received a complete revision within 1 year. DAIR procedures performed between 4 and 12 weeks (n=98) had a failure rate of 9 % (n=9). After TKA 126 DAIRs were performed in less than 4 weeks, of which 11 (9 %) received a complete revision within 1 year; 83 DAIRs were performed between 4 and 12 weeks, of which 14 (17 %) were revised. There was no significant difference in 1-year re-revision rate after a DAIR procedure by timing of the DAIR procedure for total hip and knee arthroplasty based on Dutch registry data.

scholarly journals Risk factors for periprosthetic joint infection after total knee arthroplasty in Spanish population

2019 ◽  
Author(s):  
Francisco Melchor ◽  
David Pescador ◽  
Jose Mendoza ◽  
Agustin Diaz ◽  
Agustin Soler ◽  
...  
Keyword(s):  
Risk Factors ◽  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
University Hospital ◽  
Spanish Population ◽  
Number Of Patients ◽  
Increased Risk ◽  
Total Knee

Abstract Background: Periprosthetic joint infection (PJI) is the most serious and feared complication in total knee arthroplasty (TKA) and can have catastrophic consequences. The number of total knee arthroplasties has increased and will continue to increase so that the number of infections will also be greater in the future. The aim of this study is to identify the most relevant risk factors associated with infection after a total knee prosthesis in a Spanish population. Methods: This is a case-control study of patients who underwent total knee arthroplasty at the University Hospital of Salamanca during the period January 1 2010 until January 1, 2015. TKA PJI was detected in 66 patients. As controls, a similar number of patients from the same period who did not develop a periprosthetic infection were included. Demographic and clinical variables were collected. A descriptive and inferential analysis was performed. Results: Diabetes, ASA grade, obesity and the use or not of antibiotic loaded cement were statistically significant related to the appearance of the infection. For the variables of surgical time and ischemia time, this relationship disappeared when the logistic regression was made. Conclusions: Our study provides evidence that diabetes, cement type, ASA and BMI were independently associated with increased risk of PJI for TKA patients in a Spanish population. We think that modifiable risk factors were specifically relevant and for that reason we can reduce the infection rate.

Predictors of revision, prosthetic joint infection and mortality following total hip or total knee arthroplasty in patients with rheumatoid arthritis: a nationwide cohort study using Danish healthcare registers

2017 ◽  
Vol 77 (2) ◽  
pp. 281-288 ◽  
Author(s):  
Rene Lindholm Cordtz ◽  
Kristian Zobbe ◽  
Pil Højgaard ◽  
Lars Erik Kristensen ◽  
Søren Overgaard ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Total Knee Arthroplasty ◽  
Cohort Study ◽  
Knee Arthroplasty ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Risk Of Death ◽  
Prosthetic Joint ◽  
Increased Risk ◽  
Total Knee

ObjectivesTo investigate predictors of 10-year risk of revision and 1-year risk of prosthetic joint infection (PJI) and death following total hip/total knee arthroplasty (THA/TKA) in (1) patients with rheumatoid arthritis (RA) compared with patients with osteoarthritis (OA); and (2) patients with RA treated with biological disease-modifying antirheumatic drugs (bDMARD) within 90 days preceding surgery compared with non-treated.MethodsRegister-based cohort study using the Danish National Patient Register, the DANBIO rheumatology register (RA-specific confounders and treatment episodes) and the Danish Hip and Knee Arthroplasty Registers. Survival analyses were used to calculate confounder-adjusted sub-HRs (SHR) and HRs.ResultsIn total, 3913 patients with RA with THA/TKA were compared with 120 499 patients with OA. Patients with RA had decreased risk of revision (SHR 0.71 (0.57–0.89)), but increased risk of PJI (SHR=1.46 (1.13–1.88)) and death (HR=1.25 (1.01–1.55)). In DANBIO, 345 of 1946 patients with RA with THA/TKA had received bDMARD treatment within 90 days preceding surgery. bDMARD-treated patients did not have a statistically significant increased risk of revision (SHR=1.49 (0.65–3.40)), PJI (SHR=1.61 (0.70–3.69)) nor death (HR=0.75 (0.24–2.33)) compared with non-treated. Glucocorticoid exposure (HR=2.87 (1.12–7.34)) and increasing DAS28 (HR=1.49 (1.01–2.20)) were risk factors for mortality.ConclusionPatients with RA had a decreased 10-year risk of revision while the risk of death and PJI was increased compared with patients with OA following THA/TKA. bDMARD exposure was not associated with statistically significant increased risk of neither PJI nor death in this study. Glucocorticoid exposure and increased disease activity were associated with an increased risk of death.

scholarly journals Using Group-Based Trajectory Temperature Modeling to Predict Postoperative Infections after Total Knee Arthroplasty

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S338-S339
Author(s):  
Jennifer Grant ◽  
Moira C Mcnulty ◽  
Krista Kinnard ◽  
Daniel Nagin ◽  
Ari Robicsek ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Logistic Regression ◽  
Knee Arthroplasty ◽  
Infectious Complications ◽  
Surgery Patient ◽  
Increased Risk ◽  
Total Knee ◽  
Group 3 ◽  
Postoperative Setting ◽  
Group 1

Abstract Background Fever is common in the postoperative setting and frequently physiologic. Despite this, roughly half of febrile patients undergo testing for infectious complications, of which only a few reveal infection. We analyzed whether temperature trajectories could help optimize postoperative (post-op) risk assessment in total knee arthroplasty (TKA) patients. Methods We included adult patients who underwent primary TKA between January 1, 2007–December 31, 2013 within NorthShore University HealthSystem. Patients were excluded if infection was suspected before/during surgery. Patient data were extracted from the Database Warehouse. A physician verified post-op complications by chart review. We performed group-based trajectory modeling (GBTM) with covariates: age, BMI, gender, co-morbid conditions and procedure time (STATA). We compared complications per group by χ2 test and evaluated associations with any post-op complication by multivariable (MV) logistic regression (SPSS). Results We identified 5495 independent patients, following three distinct temperature trajectories (Figure 1) – low (group 1), medium (group 2), high (group 3). Noninfectious complications were more likely than infectious complications, and complications were 5x more common in group 3 vs. group 1 (Table 1). In MV logistic regression, membership in group 3 was independently associated with developing a post-op complication, adjusting for age, presence of renal failure and presence of a cardiac arrhythmia (OR 4.4, 95% CI 3.2–6.0, P &lt; 0.01). Conclusion GBTM may help identify TKA patients at increased risk of a post-op complication in real-time, thus helping clinicians avoid unnecessary testing and antibiotics in the post-op setting. Disclosures All authors: No reported disclosures.

Combined total hip and knee arthroplasty during the same hospital admission

2019 ◽  
Vol 101-B (5) ◽  
pp. 573-581
Author(s):  
A. M. Almaguer ◽  
K. H. Cichos ◽  
G. McGwin Jr ◽  
J. M. Pearson ◽  
B. Wilson ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Joint Infection ◽  
Hospital Costs ◽  
Revision Arthroplasty ◽  
Total Hip ◽  
Vein Thrombosis ◽  
Prosthetic Joint ◽  
Increased Risk ◽  
Hip And Knee Arthroplasty ◽  
Deep Vein

Aims The purpose of this study was to compare outcomes of combined total joint arthroplasty (TJA) (total hip arthroplasty (THA) and total knee arthroplasty (TKA) performed during the same admission) versus bilateral THA, bilateral TKA, single THA, and single TKA. Combined TJAs performed on the same day were compared with those staged within the same admission episode. Patients and Methods Data from the National (Nationwide) Inpatient Sample recorded between 2005 and 2014 were used for this retrospective cohort study. Postoperative in-hospital complications, total costs, and discharge destination were reviewed. Logistic and linear regression were used to perform the statistical analyses. p-values less than 0.05 were considered statistically significant. Results Combined TJA was associated with increased risk of deep vein thrombosis, prosthetic joint infection, irrigation and debridement procedures, revision arthroplasty, length of stay (LOS), and in-hospital costs compared with bilateral THA, bilateral TKA, single THA, and single TKA. Combined TJA performed on separate days of the same admission showed no statistically significant differences when compared with same-day combined TJA, but trended towards decreased total costs and total complications despite increased LOS. Conclusion Combined TJA is associated with increased in-hospital complications, LOS, and costs. We do not recommend performing combined TJA during the same hospital stay. Cite this article: Bone Joint J 2019;101-B:573–581.

scholarly journals Seasonality of Non-SARS, Non-MERS Coronaviruses and the Impact of Meteorological Factors

Pathogens ◽  
2021 ◽  
Vol 10 (2) ◽  
pp. 187
Author(s):  
Olympia E. Anastasiou ◽  
Anika Hüsing ◽  
Johannes Korth ◽  
Fotis Theodoropoulos ◽  
Christian Taube ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Relative Humidity ◽  
Cloud Cover ◽  
Detection Rate ◽  
Logistic Regression Model ◽  
Meteorological Factors ◽  
Seasonal Pattern ◽  
Weather Factors ◽  
Immunosuppressed Patients ◽  
Immunocompetent Patients

Background: Seasonality is a characteristic of some respiratory viruses. The aim of our study was to evaluate the seasonality and the potential effects of different meteorological factors on the detection rate of the non-SARS coronavirus detection by PCR. Methods: We performed a retrospective analysis of 12,763 respiratory tract sample results (288 positive and 12,475 negative) for non-SARS, non-MERS coronaviruses (NL63, 229E, OC43, HKU1). The effect of seven single weather factors on the coronavirus detection rate was fitted in a logistic regression model with and without adjusting for other weather factors. Results: Coronavirus infections followed a seasonal pattern peaking from December to March and plunged from July to September. The seasonal effect was less pronounced in immunosuppressed patients compared to immunocompetent patients. Different automatic variable selection processes agreed on selecting the predictors temperature, relative humidity, cloud cover and precipitation as remaining predictors in the multivariable logistic regression model, including all weather factors, with low ambient temperature, low relative humidity, high cloud cover and high precipitation being linked to increased coronavirus detection rates. Conclusions: Coronavirus infections followed a seasonal pattern, which was more pronounced in immunocompetent patients compared to immunosuppressed patients. Several meteorological factors were associated with the coronavirus detection rate. However, when mutually adjusting for all weather factors, only temperature, relative humidity, precipitation and cloud cover contributed independently to predicting the coronavirus detection rate.

scholarly journals 22. Description of Hospitalized Patients with Influenza Vaccine Failure

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S35-S35
Author(s):  
Joanna Kimball ◽  
Yuwei Zhu ◽  
Dayna Wyatt ◽  
Helen Talbot
Keyword(s):  
Logistic Regression ◽  
Influenza Vaccine ◽  
Influenza Vaccination ◽  
Older Patients ◽  
Influenza A ◽  
Influenza Season ◽  
Hospitalized Patients ◽  
Vaccine Failure ◽  
Increased Risk ◽  
Immunosuppressed Patients

Abstract Background Despite influenza vaccination, some patients develop illness and require hospitalization. Many factors contribute to vaccine failure, including mismatch of the vaccine and circulating strains, waning immunity, timing of influenza season, age and patient comorbidities such as immune function. This study compared vaccinated, hospitalized patients with and without influenza. Methods This study used 2015–2019 Tennessee data from the US Hospitalized Adult Influenza Vaccine Effectiveness Network database. Enrolled patients were ≥ 18 years vaccinated for the current influenza season and admitted with an acute respiratory illness. Patient or surrogate interviews and medical chart abstractions were performed, and influenza vaccinations were confirmed by vaccine providers. Influenza PCR testing was performed in a research lab. Statistical analyses were performed with STATA and R using Pearson’s chi-squared, Kruskal-Wallis and Wilcoxon rank-sum tests and multivariate logistic regression. Results 1236 patients met study criteria, and 235 (19%) tested positive for influenza. Demographics, vaccines and comorbidities were similar between the two groups (Table 1) except for morbid obesity, which was more common in influenza negative patients (13% vs 8%, p = 0.04), and immunosuppression, which was more common in the influenza positive (63% vs 54%, p = 0.01). Logistic regression analysis demonstrated older patients (OR 1.47, 95% CI 1.03–2.10) and immunosuppressed patients (OR 1.56, 1.15–2.12) were at increased risk for influenza (Table 2 and Figure 1). Immunosuppression also increased the risk for influenza A/H3N2 (OR 1.86, 95% CI 1.25–2.75). A sensitivity analysis was performed on patients who self-reported influenza vaccination for the current season without vaccine verification and demonstrated increased risk of influenza in older adults (OR 1.66, 95% CI 1.16–2.39). Table 1: Demographics of influenza positive versus influenza negative patients in influenza vaccinated, hospitalized patients. Table 2: Logistic regression analyses of vaccinated, hospitalized influenza positive patients; vaccinated, hospitalized patients with influenza A subtypes and self-reported vaccinated, hospitalized influenza positive patients. Figure 1: Predicted Probability of Hospitalization with Influenza, Influenza A/H1N1 and Influenza A/H3N2 in Vaccinated Patients by Age. Conclusion Our study demonstrated an increased risk of influenza vaccine failure in older patients and immunosuppressed patients. These groups are also at increased risk for influenza complications. To improve protection of these patients against future influenza illnesses, more effective vaccines are needed, and more research on ring vaccination should be pursued. Disclosures All Authors: No reported disclosures

scholarly journals Prior Admissions as a Risk Factor for Readmission in Patients Surgically Treated for Femur Fractures: Implications for a Potential Hip Fracture Bundle

2021 ◽  
Vol 12 ◽  
pp. 215145932199616
Author(s):  
Robert Erlichman ◽  
Nicholas Kolodychuk ◽  
Joseph N. Gabra ◽  
Harshitha Dudipala ◽  
Brook Maxhimer ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Hip Fracture ◽  
Logistic Regression Analysis ◽  
Hip Fractures ◽  
Surgical Procedure ◽  
Hospital Admissions ◽  
Fracture Care ◽  
Increased Risk ◽  
Payment Models

Introduction: Hip fractures are a significant economic burden to our healthcare system. As there have been efforts made to create an alternative payment model for hip fracture care, it will be imperative to risk-stratify reimbursement for these medically comorbid patients. We hypothesized that patients readmitted to the hospital within 90 days would be more likely to have a recent previous hospital admission, prior to their injury. Patients with a recent prior admission could therefore be considered higher risk for readmission and increased cost. Methods: A retrospective chart review identified 598 patients who underwent surgical fixation of a hip or femur fracture. Data on readmissions within 90 days of surgical procedure and previous admissions in the year prior to injury resulting in surgical procedure were collected. Logistic regression analysis was used to determine if recent prior admission had increased risk of 90-day readmission. A subgroup analysis of geriatric hip fractures and of readmitted patients were also performed. Results: Having a prior admission within one year was significantly associated (p < 0.0001) for 90-day readmission. Specifically, logistic regression analysis revealed that a prior admission was significantly associated with 90-day readmission with an odds ratio of 7.2 (95% CI: 4.8-10.9). Discussion: This patient population has a high rate of prior hospital admissions, and these prior admissions were predictive of 90-day readmission. Alternative payment models that include penalties for readmissions or fail to apply robust risk stratification may unjustly penalize hospital systems which care for more medically complex patients. Conclusions: Hip fracture patients with a recent prior admission to the hospital are at an increased risk for 90-day readmission. This information should be considered as alternative payment models are developed for hip fracture care.

Improving Safety of Bilateral Knee Arthroplasty: Impact of Selection Criteria on Perioperative Outcome

2021 ◽  
pp. 155633162110148
Author(s):  
Philipp Gerner ◽  
Stavros G. Memtsoudis ◽  
Crispiana Cozowicz ◽  
Ottokar Stundner ◽  
Mark Figgie ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Selection Criteria ◽  
Perioperative Complications ◽  
Perioperative Outcomes ◽  
Cardiac Complications ◽  
Complication Rates ◽  
Major Complications ◽  
Increased Risk ◽  
Comorbidity Burden ◽  
Rate Ratios

Background: Bilateral total knee arthroplasty (BTKA) procedures are associated with an increased risk of complications when compared with unilateral approaches. In 2006, in an attempt to reduce this risk, our institution implemented selection criteria that specified younger and healthier patients as candidates for BTKA. Questions/Purpose: We sought to investigate the effect of these selection criteria on perioperative outcomes. Methods: In a retrospective cohort study, we used institutional data to identify patients who underwent BTKA between 1998 and 2014. Patients were divided into 2 groups: those who underwent surgery before the 2006 introduction of our selection criteria (1998–2006) and those who underwent surgery after (2007–2014). Groups were compared in terms of demographics, comorbidity burden, and incidence of perioperative complications. Regression analysis was performed, calculating incidence rate ratios to evaluate changes in complication rates. Results: Before the selection criteria were implemented in 2006, patients who underwent BTKA were older and had a higher comorbidity burden. The rate of major complications per 1000 hospital days decreased from 31.5 in 1998 to 7.9 in 2014. A reduction in cardiac complications was the most significant contributor to this decrease in major complications. Conclusion: After stringent criteria for BTKA candidates were implemented at our institution, selection of younger patients with lower comorbidity burden was accompanied by a reduction in the incidence of operative complications. This suggests that introducing such criteria can be associated with a reduction in adverse perioperative outcomes.

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