Trends in Revision Knee Arthroplasty for Prosthetic Joint Infection: A Single-Center Study of 384 Knees at a High-Volume Center Between 2008 and 2021

Periprosthetic Joint Infection: Are Patients Still Better off Than if Primary Arthroplasty Had Not Been Performed?

BACKGROUND

This study sought to evaluate patient-reported outcome measures (PROMs) before primary total joint arthroplasty (TJA) and after successful treatment for periprosthetic joint infection (PJI), with the hypothesis that patients still demonstrate clinical improvement despite the occurrence of PJI.

METHODS

A single tertiary academic center's institutional database was retrospectively reviewed for patients who underwent primary TJA, developed PJI, and were managed for PJI from January 2019 to December 2023. Patients who did not have PROMs recorded were excluded from the study. Preoperative and postoperative generic and joint-specific PROMs were collected. Patient preprimary and postfinal revision surgery for PJI PROMs were subsequently compared. The minimum follow-up after PJI treatment was 6 months. A total of 55 patients (31 total knee arthroplasty and 24 total hip arthroplasty) were included with a mean follow-up of 1.8 years (range, 6 months to 4.5 years). All PJIs were managed via debridement, antibiotics, and implant retention, 1-stage, 1.5-stage, 2-stage revision, or resection arthroplasty.

RESULTS

After final revision surgery for PJI in total knee arthroplasty, patients had lower median patient-reported outcome measure information system (PROMIS) pain interference scores than before their primary surgery (62.0 [55.0, 67.0] versus 67.0 [65.0, 70.5]; P < 0.01). However, median PROMIS physical function postfinal revision for PJI and preprimary scores were similar (38.0 [33.0, 42.0] versus 34.0 [29.5, 40.0]; P = 0.08). After final revision surgery for PJI in total hip arthroplasty, patients had lower median PROMIS pain interference scores than before their primary surgery (57.5 [53.8, 64.0] versus 68.0 [66.5, 74.0]; P < 0.01). After final revision surgery for PJI, patients also had higher median PROMIS physical function scores than before their primary surgery (39.5 [33.5, 48.2] versus 29.5 [28.8, 34.2]; P < 0.01).

CONCLUSIONS

Patients who have been successfully managed for PJI show improvement in generic and joint-specific PROMs compared to their preprimary TJA PROMs.

Declining Trends in Septic Revision Following Total Knee Arthroplasty From 2010 to 2019: A National Cohort Analysis

BACKGROUND

Periprosthetic joint infections (PJIs) following total knee arthroplasty (TKA) are associated with high patient morbidity, mortality, and health care costs. Methods to reduce the burden of PJI have been shown to be efficacious on a small scale. On a national scale, it is unknown whether these methods have reduced PJI rates.

METHODS

A retrospective trend analysis was conducted using a national database. The incidence of 2-year septic revision was observed for the entire cohort in patients who had high-risk comorbidities from 2010 to 2019. A multivariable logistic regression was performed to compare the odds ratios of 2-year septic revision rates from 2011 to 2019 to the reference year of 2010. Linear regression was used to compare the change in the overall and high-risk subanalysis groups.

RESULTS

Among the 860,185 patients, 5,589 underwent septic revision within 2 years. The 2-year septic revision rate decreased from 0.75% in 2010 to 0.69% in 2019 (compounded annual growth rate = -0.94%, P = 0.049). Multivariable logistic regressions demonstrated that the odds of septic revision in 2019 were significantly lower than those in 2010 (odds ratio: 0.83, 95% CI [confidence interval]: [0.70 to 0.96], P = 0.017). In high-risk patients, the septic revision rate decreased from 1.04 to 0.80% (compounded annual growth rate = -2.80%, P = 0.004), specifically in those who had a history of psychoses, Medicaid insurance, anemia, heart failure, obesity, liver disease, tobacco use, and drug abuse (P < 0.05 for all).

CONCLUSIONS

This study demonstrated a national reduction in the 2-year septic revision rate in all TKA patients, including patients considered at high risk for PJI. This suggests that current preventative methods may be efficacious on a national scale in TKA. Further research is needed to identify more modalities to reduce the national incidence of this morbid and costly complication.

Functional Nanomaterials for the Treatment of Osteoarthritis

Osteoarthritis (OA) is the most common degenerative joint disease, affecting more than 595 million people worldwide. Nanomaterials possess superior physicochemical properties and can influence pathological processes due to their unique structural features, such as size, surface interface, and photoelectromagnetic thermal effects. Unlike traditional OA treatments, which suffer from short half-life, low stability, poor bioavailability, and high systemic toxicity, nanotherapeutic strategies for OA offer longer half-life, enhanced targeting, improved bioavailability, and reduced systemic toxicity. These advantages effectively address the limitations of traditional therapies. This review aims to inspire researchers to develop more multifunctional nanomaterials and promote their practical application in OA treatment.

KLIC Score Does Not Predict Failure After Early Prosthetic Joint Infection: An External Validation With 153 Knees and 130 Hips

BACKGROUND

A preoperative risk score, the KLIC score (chronic renal failure [K], liver cirrhosis [L], indication of the index surgery [I], cemented prosthesis [C], and C-reactive protein >115 mg/L), has been developed to predict the risk of treatment failure after early prosthetic joint infection (PJI). This study aimed to validate the KLIC score for the debridement, antibiotics, and implant retention (DAIR) procedure and one-stage revisions in a Northern European cohort.

METHODS

Revisions due to early PJI of the hip or knee between January 1, 2008, and September 12, 2021, were identified retrospectively. The primary outcome was early failure, which was considered when the patient needed an unscheduled surgery, the patient died, or the patient was prescribed long-term suppressive antibiotics. To examine the association between KLIC score and failure risk, univariable logistic regression with area under the curve (AUC) was used. In addition, models were calibrated to assess prognostic ability and clinical utility was examined with decision-curve analyses.

RESULTS

An increase in KLIC score had a moderate predictive value for early failure after DAIR (odds ratio [OR] 1.45; confidence interval [CI] 1.13 to 1.90). For one-stage revision, it was only slightly predictive of failure (OR 1.20; CI 0.93 to 1.56). After 60 days, the AUC for DAIR was 0.63 (CI 0.55 to 0.72) and 0.56 (CI 0.46 to 0.66) for one-stage revisions, indicating poor discriminative ability. The decision-curve analyses revealed that the model did not offer a remarkable net benefit across a range of threshold probabilities.

CONCLUSIONS

We demonstrated that the KLIC score is not a reliable predictor of early failure after early PJI in a Northern European cohort. Using the model to guide treatment decisions does not provide any additional clinical utility beyond the baseline strategies.