The Journal of arthroplasty · 2025
One- Versus Two-Component Single-Stage Exchange Total Knee Arthroplasty for Periprosthetic Joint Infections: Medical Complications, Hospital Readmissions, and Failures.
СтатьяСравнительное исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Plancher Kevin D, Kalala Siddhartha C, Fleissig Jagger C, Briggs Karen K, Petterson Stephanie C
Аннотация
BACKGROUND: Single-stage revision total knee arthroplasty (TKA) can be an effective alternative to two-stage revision for periprosthetic joint infection (PJI) following TKA. The purpose of this study was to compare medical complications, hospital readmissions, and failure between one- and two-component single-stage revision TKA for PJI.
METHODS: A large national database was queried for patients who underwent single-stage revision TKA for PJI. The one- and two-component exchanges were propensity score matched by age, sex, Elixhauser Comorbidity Index (ECI), obesity, and tobacco use. There were 3,974 one-component and 3,974 two-component exchanges.
RESULTS: The one-component exchanges had significantly increased odds of readmission at 90 days with the diagnosis of infection (odds ratio [OR]: 5.3, confidence interval [CI]: 4.3 to 6.5) and six months (OR 4.9 [CI: 4.0 to 5.9]; P < 0.01). Significant predictors of infection at six months were age, ECI, anemia (OR 1.3 [CI: 1.1 to 1.4]; P < 0.001), acute kidney injury (OR 1.3 [CI: 1.1 to 1.4]; P < 0.001), and alcohol disorders (OR 1.2 [CI: 1.02 to 1.5]; P = 0.03). Failure at five years was significantly higher in the two-component exchange (OR: 1.2 [CI: 1.04 to 1.3]; P = 0.007). A two-component exchange had significantly increased odds (OR: 3.7 [CI: 2.5 to 5.4]; P < 0.001) of aseptic loosening, not infections, as the cause of failure. Significant predictors of failure at five years included age, ECI, anemia, and acute kidney injury.
CONCLUSIONS: Patients who were treated with single-stage revision TKA for PJI with a one-component exchange were five times more likely to require readmission with the diagnosis of infection. Failure rates at five years were noted to be higher in two-component exchanges due to aseptic loosening. Patient selection for revision TKA for PJI should include evaluation of all comorbidities/ECI to avoid medical readmissions with infection.
LEVEL OF EVIDENCE: Therapeutic Level III.
METHODS: A large national database was queried for patients who underwent single-stage revision TKA for PJI. The one- and two-component exchanges were propensity score matched by age, sex, Elixhauser Comorbidity Index (ECI), obesity, and tobacco use. There were 3,974 one-component and 3,974 two-component exchanges.
RESULTS: The one-component exchanges had significantly increased odds of readmission at 90 days with the diagnosis of infection (odds ratio [OR]: 5.3, confidence interval [CI]: 4.3 to 6.5) and six months (OR 4.9 [CI: 4.0 to 5.9]; P < 0.01). Significant predictors of infection at six months were age, ECI, anemia (OR 1.3 [CI: 1.1 to 1.4]; P < 0.001), acute kidney injury (OR 1.3 [CI: 1.1 to 1.4]; P < 0.001), and alcohol disorders (OR 1.2 [CI: 1.02 to 1.5]; P = 0.03). Failure at five years was significantly higher in the two-component exchange (OR: 1.2 [CI: 1.04 to 1.3]; P = 0.007). A two-component exchange had significantly increased odds (OR: 3.7 [CI: 2.5 to 5.4]; P < 0.001) of aseptic loosening, not infections, as the cause of failure. Significant predictors of failure at five years included age, ECI, anemia, and acute kidney injury.
CONCLUSIONS: Patients who were treated with single-stage revision TKA for PJI with a one-component exchange were five times more likely to require readmission with the diagnosis of infection. Failure rates at five years were noted to be higher in two-component exchanges due to aseptic loosening. Patient selection for revision TKA for PJI should include evaluation of all comorbidities/ECI to avoid medical readmissions with infection.
LEVEL OF EVIDENCE: Therapeutic Level III.