Evaluation of time to reimplantation as a risk factor in two-stage revision with static spacers for periprosthetic knee joint infection
Abstract Introduction We investigated the time to reimplantation (TTR) during two-stage revision using static spacers with regard to treatment success and function in patients with chronic periprosthetic joint infection (PJI) of the knee. Methods 163 patients (median age 72 years, 72 women) who unde...
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| Format: | Article |
| Language: | English |
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SpringerOpen
2024-03-01
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| Series: | Journal of Orthopaedics and Traumatology |
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| Online Access: | https://doi.org/10.1186/s10195-024-00745-7 |
| _version_ | 1797233416574337024 |
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| author | Jan Puetzler Marc Hofschneider Georg Gosheger Christoph Theil Martin Schulze Jan Schwarze Raphael Koch Burkhard Moellenbeck |
| author_facet | Jan Puetzler Marc Hofschneider Georg Gosheger Christoph Theil Martin Schulze Jan Schwarze Raphael Koch Burkhard Moellenbeck |
| author_sort | Jan Puetzler |
| collection | DOAJ |
| description | Abstract Introduction We investigated the time to reimplantation (TTR) during two-stage revision using static spacers with regard to treatment success and function in patients with chronic periprosthetic joint infection (PJI) of the knee. Methods 163 patients (median age 72 years, 72 women) who underwent two-stage exchange for chronic knee PJI between 2012 and 2020 were retrospectively analyzed (based on the 2011 Musculoskeletal Infection Society criteria). A cutoff TTR for increased risk of reinfection was identified using the maximally selected log-rank statistic. Infection control, aseptic revisions and overall survival were analyzed using Kaplan–Meier survival estimates. Adjustment for confounding factors—the Charlson Comorbidity Index (CCI) and C-reactive protein (CRP)—was done with a Cox proportional hazards model. Results When TTR exceeded 94 days, the adjusted hazard of reinfection was increased 2.8-fold (95% CI 1.4–5.7; p = 0.0036). The reinfection-free rate was 67% (95% CI 52-79%) after 2 years and 33% (95% CI 11–57%) after 5 years for a longer TTR compared to 89% (95% CI 81–94%) and 80% (95% CI 69–87%) at 2 and 5 years, respectively, for a shorter TTR. Adjusted overall survival and number of aseptic revisions did not differ between the longer TTR and shorter TTR groups. Maximum knee flexion was 90° (IQR 84–100) for a longer TTR and 95° (IQR 90–100) for a shorter TTR (p = 0.0431), with no difference between the groups in Oxford Knee Score. Baseline characteristics were similar (body mass index, age, previous surgeries, microorganisms) for the two groups, except that there was a higher CCI (median 4 vs. 3) and higher CRP (median 3.7 vs 2.6 mg/dl) in the longer TTR group. Conclusion A long TTR is sometimes unavoidable in clinical practice, but surgeons should be aware of a potentially higher risk of reinfection. Level of evidence: III, retrospective comparative study. |
| first_indexed | 2024-04-24T16:15:49Z |
| format | Article |
| id | doaj.art-bee6673d8fb043f29c7fcdd763a21f22 |
| institution | Directory Open Access Journal |
| issn | 1590-9999 |
| language | English |
| last_indexed | 2024-04-24T16:15:49Z |
| publishDate | 2024-03-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Journal of Orthopaedics and Traumatology |
| spelling | doaj.art-bee6673d8fb043f29c7fcdd763a21f222024-03-31T11:28:39ZengSpringerOpenJournal of Orthopaedics and Traumatology1590-99992024-03-0125111110.1186/s10195-024-00745-7Evaluation of time to reimplantation as a risk factor in two-stage revision with static spacers for periprosthetic knee joint infectionJan Puetzler0Marc Hofschneider1Georg Gosheger2Christoph Theil3Martin Schulze4Jan Schwarze5Raphael Koch6Burkhard Moellenbeck7Department of Orthopaedics and Tumor Orthopaedics, Muenster University HospitalDepartment of Orthopaedics and Tumor Orthopaedics, Muenster University HospitalDepartment of Orthopaedics and Tumor Orthopaedics, Muenster University HospitalDepartment of Orthopaedics and Tumor Orthopaedics, Muenster University HospitalDepartment of Orthopaedics and Tumor Orthopaedics, Muenster University HospitalDepartment of Orthopaedics and Tumor Orthopaedics, Muenster University HospitalInstitute of Biostatistics and Clinical Research, University of MuensterDepartment of Orthopaedics and Tumor Orthopaedics, Muenster University HospitalAbstract Introduction We investigated the time to reimplantation (TTR) during two-stage revision using static spacers with regard to treatment success and function in patients with chronic periprosthetic joint infection (PJI) of the knee. Methods 163 patients (median age 72 years, 72 women) who underwent two-stage exchange for chronic knee PJI between 2012 and 2020 were retrospectively analyzed (based on the 2011 Musculoskeletal Infection Society criteria). A cutoff TTR for increased risk of reinfection was identified using the maximally selected log-rank statistic. Infection control, aseptic revisions and overall survival were analyzed using Kaplan–Meier survival estimates. Adjustment for confounding factors—the Charlson Comorbidity Index (CCI) and C-reactive protein (CRP)—was done with a Cox proportional hazards model. Results When TTR exceeded 94 days, the adjusted hazard of reinfection was increased 2.8-fold (95% CI 1.4–5.7; p = 0.0036). The reinfection-free rate was 67% (95% CI 52-79%) after 2 years and 33% (95% CI 11–57%) after 5 years for a longer TTR compared to 89% (95% CI 81–94%) and 80% (95% CI 69–87%) at 2 and 5 years, respectively, for a shorter TTR. Adjusted overall survival and number of aseptic revisions did not differ between the longer TTR and shorter TTR groups. Maximum knee flexion was 90° (IQR 84–100) for a longer TTR and 95° (IQR 90–100) for a shorter TTR (p = 0.0431), with no difference between the groups in Oxford Knee Score. Baseline characteristics were similar (body mass index, age, previous surgeries, microorganisms) for the two groups, except that there was a higher CCI (median 4 vs. 3) and higher CRP (median 3.7 vs 2.6 mg/dl) in the longer TTR group. Conclusion A long TTR is sometimes unavoidable in clinical practice, but surgeons should be aware of a potentially higher risk of reinfection. Level of evidence: III, retrospective comparative study.https://doi.org/10.1186/s10195-024-00745-7Prosthetic joint infectionTwo-stage exchange revision arthroplastyTKATHA |
| spellingShingle | Jan Puetzler Marc Hofschneider Georg Gosheger Christoph Theil Martin Schulze Jan Schwarze Raphael Koch Burkhard Moellenbeck Evaluation of time to reimplantation as a risk factor in two-stage revision with static spacers for periprosthetic knee joint infection Journal of Orthopaedics and Traumatology Prosthetic joint infection Two-stage exchange revision arthroplasty TKA THA |
| title | Evaluation of time to reimplantation as a risk factor in two-stage revision with static spacers for periprosthetic knee joint infection |
| title_full | Evaluation of time to reimplantation as a risk factor in two-stage revision with static spacers for periprosthetic knee joint infection |
| title_fullStr | Evaluation of time to reimplantation as a risk factor in two-stage revision with static spacers for periprosthetic knee joint infection |
| title_full_unstemmed | Evaluation of time to reimplantation as a risk factor in two-stage revision with static spacers for periprosthetic knee joint infection |
| title_short | Evaluation of time to reimplantation as a risk factor in two-stage revision with static spacers for periprosthetic knee joint infection |
| title_sort | evaluation of time to reimplantation as a risk factor in two stage revision with static spacers for periprosthetic knee joint infection |
| topic | Prosthetic joint infection Two-stage exchange revision arthroplasty TKA THA |
| url | https://doi.org/10.1186/s10195-024-00745-7 |
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