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Infection After Unicompartmental Knee Arthroplasty: A High Risk of Subsequent Complications.
Clin Orthop Relat Res 2019; 477(1):70-77CO

Abstract

BACKGROUND

Unicompartmental knee arthroplasty restores function and improves pain in appropriately selected patients. Scant evidence exists regarding the treatment of periprosthetic joint infection (PJI) after unicompartmental knee arthroplasty (UKA).

QUESTIONS/PURPOSES

(1) What was the overall survivorship free from reinfection? (2) What is the survivorship free of all-cause revision? (3) What are the Knee Society scores (KSS) and complications after surgical treatment of UKA PJI?

METHODS

This retrospective study with data drawn from a longitudinally maintained institutional registry identified 15 UKA PJIs between 1992 and 2014. The median age at PJI diagnosis was 58 years (range, 41-82 years), nine of 15 were men, and the median body mass index was 29 kg/m (range, 23-36 kg/m). Ten patients (10 of 15) satisfied major Musculoskeletal Infection Society diagnostic criteria. There were five patients (five of 15) with early postoperative infections, five (five of 15) with acute hematogenous infections, and five (five of 15) with chronic PJIs. Two-stage exchange was performed in four patients with PJIs (four of 15), and débridement, antibiotics, and implant retention (DAIR) was performed in 11 patients (11 of 15) with PJIs. We performed Kaplan-Meier survivorship analysis for reinfection and revision procedures. Thirteen patients had a minimum of 2 years' followup and were included in the clinical analysis. Median followup was 4 years (range, 2-6 years). We calculated KSS.

RESULTS

Infection-free survivorship was 71% at 5 years (95% confidence interval [CI], 46%-96%). Treatment success was higher for patients undergoing two-stage exchange (100% at 5 years; 95% CI, 100%-100%) versus DAIR (61% at 5 years; 95% CI, 31%-92%). Four of 11 patients undergoing DAIR had developed a reinfection at final followup. Survivorship free of any revision was 49% at 5 years (95% CI, 19%-79%). One patient from the two-stage exchange cohort underwent femoral component revision for aseptic loosening 5 years after PJI treatment, and two patients from the DAIR group were converted to TKA for disease progression at a mean of 4 years. In patients with a minimum of 2 years' followup, median KSS improved from 73 (range, 50-93) before index UKA to 94 (range, 55-100; p = 0.016).

CONCLUSIONS

Treatment of UKA PJI with DAIR was associated with a lower infection-free survivorship at 5 years compared with two-stage exchange with conversion to TKA. Among those patients who were infection-free, a number needed reoperations for disease progression (in the DAIR group) or component loosening (in both groups). UKA PJI results in substantial morbidity, and patients with these infections should be followed closely for aseptic causes of failure in addition to infection recurrence.

LEVEL OF EVIDENCE

Level IV, therapeutic study.

Authors+Show Affiliations

Nicholas J. Hernandez MD, Stephen M. Petis MD, Arlen D. Hanssen MD, Rafael J. Sierra MD, Matthew P. Abdel MD, Mark W. Pagnano MD, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30794230

Citation

Hernandez, Nicholas M., et al. "Infection After Unicompartmental Knee Arthroplasty: a High Risk of Subsequent Complications." Clinical Orthopaedics and Related Research, vol. 477, no. 1, 2019, pp. 70-77.
Hernandez NM, Petis SM, Hanssen AD, et al. Infection After Unicompartmental Knee Arthroplasty: A High Risk of Subsequent Complications. Clin Orthop Relat Res. 2019;477(1):70-77.
Hernandez, N. M., Petis, S. M., Hanssen, A. D., Sierra, R. J., Abdel, M. P., & Pagnano, M. W. (2019). Infection After Unicompartmental Knee Arthroplasty: A High Risk of Subsequent Complications. Clinical Orthopaedics and Related Research, 477(1), pp. 70-77. doi:10.1097/CORR.0000000000000372.
Hernandez NM, et al. Infection After Unicompartmental Knee Arthroplasty: a High Risk of Subsequent Complications. Clin Orthop Relat Res. 2019;477(1):70-77. PubMed PMID: 30794230.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Infection After Unicompartmental Knee Arthroplasty: A High Risk of Subsequent Complications. AU - Hernandez,Nicholas M, AU - Petis,Stephen M, AU - Hanssen,Arlen D, AU - Sierra,Rafael J, AU - Abdel,Matthew P, AU - Pagnano,Mark W, PY - 2020/01/01/pmc-release PY - 2019/2/23/entrez PY - 2019/2/23/pubmed PY - 2019/10/23/medline SP - 70 EP - 77 JF - Clinical orthopaedics and related research JO - Clin. Orthop. Relat. Res. VL - 477 IS - 1 N2 - BACKGROUND: Unicompartmental knee arthroplasty restores function and improves pain in appropriately selected patients. Scant evidence exists regarding the treatment of periprosthetic joint infection (PJI) after unicompartmental knee arthroplasty (UKA). QUESTIONS/PURPOSES: (1) What was the overall survivorship free from reinfection? (2) What is the survivorship free of all-cause revision? (3) What are the Knee Society scores (KSS) and complications after surgical treatment of UKA PJI? METHODS: This retrospective study with data drawn from a longitudinally maintained institutional registry identified 15 UKA PJIs between 1992 and 2014. The median age at PJI diagnosis was 58 years (range, 41-82 years), nine of 15 were men, and the median body mass index was 29 kg/m (range, 23-36 kg/m). Ten patients (10 of 15) satisfied major Musculoskeletal Infection Society diagnostic criteria. There were five patients (five of 15) with early postoperative infections, five (five of 15) with acute hematogenous infections, and five (five of 15) with chronic PJIs. Two-stage exchange was performed in four patients with PJIs (four of 15), and débridement, antibiotics, and implant retention (DAIR) was performed in 11 patients (11 of 15) with PJIs. We performed Kaplan-Meier survivorship analysis for reinfection and revision procedures. Thirteen patients had a minimum of 2 years' followup and were included in the clinical analysis. Median followup was 4 years (range, 2-6 years). We calculated KSS. RESULTS: Infection-free survivorship was 71% at 5 years (95% confidence interval [CI], 46%-96%). Treatment success was higher for patients undergoing two-stage exchange (100% at 5 years; 95% CI, 100%-100%) versus DAIR (61% at 5 years; 95% CI, 31%-92%). Four of 11 patients undergoing DAIR had developed a reinfection at final followup. Survivorship free of any revision was 49% at 5 years (95% CI, 19%-79%). One patient from the two-stage exchange cohort underwent femoral component revision for aseptic loosening 5 years after PJI treatment, and two patients from the DAIR group were converted to TKA for disease progression at a mean of 4 years. In patients with a minimum of 2 years' followup, median KSS improved from 73 (range, 50-93) before index UKA to 94 (range, 55-100; p = 0.016). CONCLUSIONS: Treatment of UKA PJI with DAIR was associated with a lower infection-free survivorship at 5 years compared with two-stage exchange with conversion to TKA. Among those patients who were infection-free, a number needed reoperations for disease progression (in the DAIR group) or component loosening (in both groups). UKA PJI results in substantial morbidity, and patients with these infections should be followed closely for aseptic causes of failure in addition to infection recurrence. LEVEL OF EVIDENCE: Level IV, therapeutic study. SN - 1528-1132 UR - https://www.unboundmedicine.com/medline/citation/30794230/Infection_After_Unicompartmental_Knee_Arthroplasty:_A_High_Risk_of_Subsequent_Complications_ L2 - http://Insights.ovid.com/pubmed?pmid=30794230 DB - PRIME DP - Unbound Medicine ER -