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Revision Total Knee Arthroplasty Infection: Incidence and Predictors

  • Symposium: Papers Presented at the 2009 Meeting of the Musculoskeletal Infection Society
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Deep infection remains one of the most devastating and costly complications after total knee arthroplasty (TKA). The risk of deep infection after revision TKA is reportedly greater than that for primary TKA; however, we do not know the exact incidence of infection after revision TKA.

Questions/purposes

We determined the incidence of infection after revision, the type of microorganisms involved and TKA, and the potential risk factors for this infection.

Methods

We retrospectively reviewed 475 patients (476 knees) with 499 TKA revisions performed between March 1998 and December 2005. Of the 476 knees, 91 (19%) were revised for infection and 385 (81%) were revised for aseptic failure. Preoperative history, results of physical examinations, laboratory and radiographic results, joint fluid aspiration results along with analysis of intraoperative findings were all considered to make an assessment of septic versus aseptic failure modes. Patients were followed for a minimum of 25 months (mean, 65 months; range, 25–159 months).

Results

Deep infection developed in 44 of the 476 knees (9%). The infection rate was higher in patients undergoing revision for infection than in patients with aseptic revisions: 21% (23 of 91) and 5% (21 of 385), respectively. Revision for infection, higher Charlson index, and diagnosis other than osteoarthritis at the time of primary TKA predicted infection of the revision. The risk of infection for patients undergoing TKA revisions was 10-fold higher than for patients undergoing primary TKA at our institution.

Conclusions

Infection of primary TKA is the most important risk factor for subsequent infection of TKA revisions.

Level of Evidence

Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Imam University Hospital, Tehran University of Medical Sciences, End of Keshavarz Blvd, Tehran, 1419733141, Iran

    S. M. Javad Mortazavi MD

  2. Rothman Institute of Orthopedics at Thomas Jefferson University Hospital, 925 Chestnut Street, Philadelphia, PA, 19107, USA

    Justin Schwartzenberger BS, Matthew S. Austin MD, James J. Purtill MD & Javad Parvizi MD, FRCS

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  1. S. M. Javad Mortazavi MD
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  2. Justin Schwartzenberger BS
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  3. Matthew S. Austin MD
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  4. James J. Purtill MD
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  5. Javad Parvizi MD, FRCS
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Correspondence to Javad Parvizi MD, FRCS.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

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Mortazavi, S.M.J., Schwartzenberger, J., Austin, M.S. et al. Revision Total Knee Arthroplasty Infection: Incidence and Predictors. Clin Orthop Relat Res 468, 2052–2059 (2010). https://doi.org/10.1007/s11999-010-1308-6

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  • DOI: https://doi.org/10.1007/s11999-010-1308-6

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