Abstract
Background
Periprosthetic joint infection (PJI) after knee arthroplasty surgery remains a serious complication. Yet, there is no international consensus on the surgical treatment of PJI. The purpose was to assess the prosthesis survival rates, risk of re-revision, and mortality rate following the different surgical strategies (1-stage or 2-stage implant revision, and irrigation and debridement (IAD) with implant retention) used to treat PJI.
Methods
The study was based on 653 total knee arthroplasties (TKAs) revised due to PJI in the period 1994 to 2016. Kaplan-Meier (KM) and multiple Cox regression analyses were performed to assess the survival rate of these revisions and the risk of re-revisions. We also studied the mortality rates at 90 days and 1 year after revision for PJI.
Results
Of the 653 revision TKAs; 329, 81, and 243 revisions were performed with IAD, 1-stage, and 2-stage revision procedures, respectively. During the follow-up period, 19%, 12.3% and 11.5% of the IAD, 1-stage, and 2-stage revision cases were re-revised due to PJI, respectively. With any reasons of re-revision as end-point the 5 year KM survival of the index revision procedure was 76%, 82%, and 84% after IAD, 1-stage, and 2-stage revision, respectively. Similarly, the 5-year KM survival with a re-revision for infection as end-point was 79%, 88%, and 87% after IAD, 1-stage, and 2-stage revision, respectively. There were no statistically significant differences between 1-stage and 2-stage revision for re-revision of any reasons (RR=1.6; 95% CI: 0.8–3.1) nor did we find a difference for re-revision due to deep infection (RR=1.4; 95% CI: 0.6–3.1) as end-point. In an age-stratified analysis, however, the risk of re-revision for any causes was 4 times increased after 1-stage revision compared to 2-stage revision in patients over 70 years of age (RR=4.2, 95% CI: 1.3–13.7) but the risk was similar for deep infection as end-point. Age had no statistically significant effect on the risk of re-revision for knees revised with the IAD procedure. The 90-days and 1-year mortality rate after revision for PJI were 2.1% and 3.6% after IAD, 1.2% and 1.2% after 1-stage revision, and 0.4% and 1.6% after 2-stage revision and there were no statistically significant differences in mortality rate according to revision procedure.
Conclusion
IAD had good results compared to earlier published studies. Despite that 1-stage revisions had a 4 times higher risk for re-revision compared to 2-stage revisions in older patients, the overall outcomes after 1-stage and 2-stage revision were similar
