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