Rotating Hinge Knee Arthroplasty for Revision Prosthetic-Knee Infection: Good Functional Outcomes but a Crucial Need for Superinfection Prevention
Introduction: Management of chronic infection following total knee arthroplasty (TKA) is challenging. Rotating hinged prostheses are often required in this setting due to severe bone loss, ligamentous insufficiency, or a combination of the two. The nature of the mechanical and septic complications o...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2021-09-01
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| Series: | Frontiers in Surgery |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fsurg.2021.551814/full |
| _version_ | 1819105511097761792 |
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| author | Florian Bourbotte-Salmon Tristan Ferry Tristan Ferry Tristan Ferry Tristan Ferry Mickaël Cardinale Elvire Servien Elvire Servien Elvire Servien Frédéric Rongieras Michel-Henry Fessy Michel-Henry Fessy Michel-Henry Fessy Antoine Bertani Frédéric Laurent Frédéric Laurent Frédéric Laurent Margaux Buffe-Lidove Cécile Batailler Cécile Batailler Cécile Batailler Sébastien Lustig Sébastien Lustig Sébastien Lustig The Lyon Bone and Joint Infections Study Group |
| author_facet | Florian Bourbotte-Salmon Tristan Ferry Tristan Ferry Tristan Ferry Tristan Ferry Mickaël Cardinale Elvire Servien Elvire Servien Elvire Servien Frédéric Rongieras Michel-Henry Fessy Michel-Henry Fessy Michel-Henry Fessy Antoine Bertani Frédéric Laurent Frédéric Laurent Frédéric Laurent Margaux Buffe-Lidove Cécile Batailler Cécile Batailler Cécile Batailler Sébastien Lustig Sébastien Lustig Sébastien Lustig The Lyon Bone and Joint Infections Study Group |
| author_sort | Florian Bourbotte-Salmon |
| collection | DOAJ |
| description | Introduction: Management of chronic infection following total knee arthroplasty (TKA) is challenging. Rotating hinged prostheses are often required in this setting due to severe bone loss, ligamentous insufficiency, or a combination of the two. The nature of the mechanical and septic complications occurring in this setting has not been well-described. The aim of this study was to evaluate patient outcomes using a hinge knee prosthesis for prosthetic knee infections and to investigate risk factors for implant removal.Methods: This was a retrospective cohort study that included all patients treated in our tertiary level referral center between January 2009 and December 2016 for prosthetic knee infection with a hinge knee prosthesis. Only patients with a minimum 2-year of follow-up were included. Functional evaluation was performed using international knee society (IKS) “Knee” and “Function” scores. Survival analysis comparing implant removal risks for mechanical and septic causes was performed using Cox univariate analysis and Kaplan-Meier curves. Risk factors for implant removal and septic failure were assessed.Results: Forty-six knees were eligible for inclusion. The majority of patients had satisfactory functional outcomes as determined by mean IKS scores (mean knee score: 70.53, mean function score: 46.53 points, and mean knee flexion: 88.75°). The 2-year implant survival rate was 89% but dropped to 65% at 7 years follow-up. The risk of failure (i.e., implant removal) was higher for septic etiology compared to mechanical causes. Patients with American society of anesthesiologists (ASA) score>1, immunosuppression, or with peripheral arterial diseases had a higher risk for septic failure. Patients with acute infection according to the Tsukayamaclassification had a higher risk of failure. Of the 46 patients included, 19 (41.3%) had atleast one infectious event on the surgical knee and most of these were superinfections (14/19) with new pathogens isolated. Among pathogens responsible for superinfections (i) cefazolin and gentamicin were both active in six of the cases but failed to prevent the superinfection; (ii) cefazolin and/or gentamicin were not active in eight patients, leading to alternative systemic and/or local antimicrobial prophylaxis consideration.Conclusions: Patients with chronic total knee arthroplasty (TKA) infection, requiring revision using rotating hinge implant, had good functional outcomes but experienced a high rate of septic failure, mostly due to bacterial superinfection. These patients may need optimal antimicrobial systemic prophylaxis and innovative approaches to reduce the rate of superinfection. |
| first_indexed | 2024-12-22T02:23:24Z |
| format | Article |
| id | doaj.art-931de70823f046b9a22d2fe9a4c9ae6d |
| institution | Directory Open Access Journal |
| issn | 2296-875X |
| language | English |
| last_indexed | 2024-12-22T02:23:24Z |
| publishDate | 2021-09-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Surgery |
| spelling | doaj.art-931de70823f046b9a22d2fe9a4c9ae6d2022-12-21T18:42:05ZengFrontiers Media S.A.Frontiers in Surgery2296-875X2021-09-01810.3389/fsurg.2021.551814551814Rotating Hinge Knee Arthroplasty for Revision Prosthetic-Knee Infection: Good Functional Outcomes but a Crucial Need for Superinfection PreventionFlorian Bourbotte-Salmon0Tristan Ferry1Tristan Ferry2Tristan Ferry3Tristan Ferry4Mickaël Cardinale5Elvire Servien6Elvire Servien7Elvire Servien8Frédéric Rongieras9Michel-Henry Fessy10Michel-Henry Fessy11Michel-Henry Fessy12Antoine Bertani13Frédéric Laurent14Frédéric Laurent15Frédéric Laurent16Margaux Buffe-Lidove17Cécile Batailler18Cécile Batailler19Cécile Batailler20Sébastien Lustig21Sébastien Lustig22Sébastien Lustig23The Lyon Bone and Joint Infections Study GroupDepartment of Orthopaedic and Traumatologic Surgery, Hôpital Edouard Herriot, Lyon, FranceService des Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, FranceUniversité Claude Bernard Lyon 1, Lyon, FranceCentre interrégional de Référence pour la prise en charge des Infections Ostéo-Articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, FranceCIRI – Centre International de Recherche en Infectiologie, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, Lyon, FranceDepartment of Anesthesiology and Intensive Care, Hôpital d'Instruction des Armées Saint-Anne, Toulon, FranceUniversité Claude Bernard Lyon 1, Lyon, FranceCentre interrégional de Référence pour la prise en charge des Infections Ostéo-Articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, FranceDepartment of Orthopaedic and Sport Surgery, Hôpital de la Croix Rousse, Lyon, FranceDepartment of Orthopaedic and Traumatologic Surgery, Hôpital Edouard Herriot, Lyon, FranceUniversité Claude Bernard Lyon 1, Lyon, FranceCentre interrégional de Référence pour la prise en charge des Infections Ostéo-Articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, FranceDepartment of Orthopaedic and Traumatologic surgery, Centre Hospitalier Lyon Sud, Pierre-Bénite, FranceDepartment of Orthopaedic and Traumatologic Surgery, Hôpital Edouard Herriot, Lyon, FranceUniversité Claude Bernard Lyon 1, Lyon, FranceCentre interrégional de Référence pour la prise en charge des Infections Ostéo-Articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, FranceInstitut des Agents Infectieux, Hôpital de la Croix Rousse, Lyon, France0Department of Physical and Rehabilitation Medicine, Hôpital d'Instruction des Armées Desgenettes, Lyon, FranceUniversité Claude Bernard Lyon 1, Lyon, FranceCentre interrégional de Référence pour la prise en charge des Infections Ostéo-Articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, FranceDepartment of Orthopaedic and Sport Surgery, Hôpital de la Croix Rousse, Lyon, FranceUniversité Claude Bernard Lyon 1, Lyon, FranceCentre interrégional de Référence pour la prise en charge des Infections Ostéo-Articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, FranceDepartment of Orthopaedic and Sport Surgery, Hôpital de la Croix Rousse, Lyon, FranceIntroduction: Management of chronic infection following total knee arthroplasty (TKA) is challenging. Rotating hinged prostheses are often required in this setting due to severe bone loss, ligamentous insufficiency, or a combination of the two. The nature of the mechanical and septic complications occurring in this setting has not been well-described. The aim of this study was to evaluate patient outcomes using a hinge knee prosthesis for prosthetic knee infections and to investigate risk factors for implant removal.Methods: This was a retrospective cohort study that included all patients treated in our tertiary level referral center between January 2009 and December 2016 for prosthetic knee infection with a hinge knee prosthesis. Only patients with a minimum 2-year of follow-up were included. Functional evaluation was performed using international knee society (IKS) “Knee” and “Function” scores. Survival analysis comparing implant removal risks for mechanical and septic causes was performed using Cox univariate analysis and Kaplan-Meier curves. Risk factors for implant removal and septic failure were assessed.Results: Forty-six knees were eligible for inclusion. The majority of patients had satisfactory functional outcomes as determined by mean IKS scores (mean knee score: 70.53, mean function score: 46.53 points, and mean knee flexion: 88.75°). The 2-year implant survival rate was 89% but dropped to 65% at 7 years follow-up. The risk of failure (i.e., implant removal) was higher for septic etiology compared to mechanical causes. Patients with American society of anesthesiologists (ASA) score>1, immunosuppression, or with peripheral arterial diseases had a higher risk for septic failure. Patients with acute infection according to the Tsukayamaclassification had a higher risk of failure. Of the 46 patients included, 19 (41.3%) had atleast one infectious event on the surgical knee and most of these were superinfections (14/19) with new pathogens isolated. Among pathogens responsible for superinfections (i) cefazolin and gentamicin were both active in six of the cases but failed to prevent the superinfection; (ii) cefazolin and/or gentamicin were not active in eight patients, leading to alternative systemic and/or local antimicrobial prophylaxis consideration.Conclusions: Patients with chronic total knee arthroplasty (TKA) infection, requiring revision using rotating hinge implant, had good functional outcomes but experienced a high rate of septic failure, mostly due to bacterial superinfection. These patients may need optimal antimicrobial systemic prophylaxis and innovative approaches to reduce the rate of superinfection.https://www.frontiersin.org/articles/10.3389/fsurg.2021.551814/fullarthroplastytotal knee arthroplastyknee prosthesisprosthetic-joint infectionseptic revisionsuperinfection |
| spellingShingle | Florian Bourbotte-Salmon Tristan Ferry Tristan Ferry Tristan Ferry Tristan Ferry Mickaël Cardinale Elvire Servien Elvire Servien Elvire Servien Frédéric Rongieras Michel-Henry Fessy Michel-Henry Fessy Michel-Henry Fessy Antoine Bertani Frédéric Laurent Frédéric Laurent Frédéric Laurent Margaux Buffe-Lidove Cécile Batailler Cécile Batailler Cécile Batailler Sébastien Lustig Sébastien Lustig Sébastien Lustig The Lyon Bone and Joint Infections Study Group Rotating Hinge Knee Arthroplasty for Revision Prosthetic-Knee Infection: Good Functional Outcomes but a Crucial Need for Superinfection Prevention Frontiers in Surgery arthroplasty total knee arthroplasty knee prosthesis prosthetic-joint infection septic revision superinfection |
| title | Rotating Hinge Knee Arthroplasty for Revision Prosthetic-Knee Infection: Good Functional Outcomes but a Crucial Need for Superinfection Prevention |
| title_full | Rotating Hinge Knee Arthroplasty for Revision Prosthetic-Knee Infection: Good Functional Outcomes but a Crucial Need for Superinfection Prevention |
| title_fullStr | Rotating Hinge Knee Arthroplasty for Revision Prosthetic-Knee Infection: Good Functional Outcomes but a Crucial Need for Superinfection Prevention |
| title_full_unstemmed | Rotating Hinge Knee Arthroplasty for Revision Prosthetic-Knee Infection: Good Functional Outcomes but a Crucial Need for Superinfection Prevention |
| title_short | Rotating Hinge Knee Arthroplasty for Revision Prosthetic-Knee Infection: Good Functional Outcomes but a Crucial Need for Superinfection Prevention |
| title_sort | rotating hinge knee arthroplasty for revision prosthetic knee infection good functional outcomes but a crucial need for superinfection prevention |
| topic | arthroplasty total knee arthroplasty knee prosthesis prosthetic-joint infection septic revision superinfection |
| url | https://www.frontiersin.org/articles/10.3389/fsurg.2021.551814/full |
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