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Journal of Orthopaedics and Traumatology
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Evaluation of time to reimplantation as a risk factor in two-stage revision with static spacers for periprosthetic knee joint infection

Authors: Puetzler, Jan; Hofschneider, Marc; Gosheger, Georg; Theil, Christoph; Schulze, Martin; Schwarze, Jan; Koch, Raphael; +1 Authors

Evaluation of time to reimplantation as a risk factor in two-stage revision with static spacers for periprosthetic knee joint infection

Abstract

Abstract Introduction We investigated the time to reimplantation (TTR) during two-stage revision using static spacers with regard to treatment success and function in patients with chronic periprosthetic joint infection (PJI) of the knee. Methods 163 patients (median age 72 years, 72 women) who underwent two-stage exchange for chronic knee PJI between 2012 and 2020 were retrospectively analyzed (based on the 2011 Musculoskeletal Infection Society criteria). A cutoff TTR for increased risk of reinfection was identified using the maximally selected log-rank statistic. Infection control, aseptic revisions and overall survival were analyzed using Kaplan–Meier survival estimates. Adjustment for confounding factors—the Charlson Comorbidity Index (CCI) and C-reactive protein (CRP)—was done with a Cox proportional hazards model. Results When TTR exceeded 94 days, the adjusted hazard of reinfection was increased 2.8-fold (95% CI 1.4–5.7; p = 0.0036). The reinfection-free rate was 67% (95% CI 52-79%) after 2 years and 33% (95% CI 11–57%) after 5 years for a longer TTR compared to 89% (95% CI 81–94%) and 80% (95% CI 69–87%) at 2 and 5 years, respectively, for a shorter TTR. Adjusted overall survival and number of aseptic revisions did not differ between the longer TTR and shorter TTR groups. Maximum knee flexion was 90° (IQR 84–100) for a longer TTR and 95° (IQR 90–100) for a shorter TTR (p = 0.0431), with no difference between the groups in Oxford Knee Score. Baseline characteristics were similar (body mass index, age, previous surgeries, microorganisms) for the two groups, except that there was a higher CCI (median 4 vs. 3) and higher CRP (median 3.7 vs 2.6 mg/dl) in the longer TTR group. Conclusion A long TTR is sometimes unavoidable in clinical practice, but surgeons should be aware of a potentially higher risk of reinfection. Level of evidence: III, retrospective comparative study.

Keywords

THA, Reoperation, Prosthetic joint infection, Prosthesis-Related Infections, Knee Joint, Risk Factors, Humans, Arthroplasty, Replacement, Knee, Aged, Retrospective Studies, Orthopedic surgery, Arthritis, Infectious, TKA, Treatment Outcome, C-Reactive Protein, Reinfection, Replantation, Two-stage exchange revision arthroplasty, Original Article, Female, Knee Prosthesis, RD701-811, Prosthesis-Related Infections/etiology [MeSH] ; Female [MeSH] ; Reinfection/complications [MeSH] ; C-Reactive Protein [MeSH] ; Aged [MeSH] ; Two-stage exchange revision arthroplasty ; Humans [MeSH] ; Treatment Outcome [MeSH] ; Knee Joint/surgery [MeSH] ; Retrospective Studies [MeSH] ; Risk Factors [MeSH] ; THA ; Prosthesis-Related Infections/surgery [MeSH] ; Reoperation [MeSH] ; Arthroplasty, Replacement, Knee/adverse effects [MeSH] ; TKA ; Original Article ; Knee Prosthesis/adverse effects [MeSH] ; Prosthetic joint infection ; Arthritis, Infectious/complications [MeSH] ; Replantation/adverse effects [MeSH]

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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
6
Top 10%
Average
Top 10%
Green
gold