Periprosthetic Joint Infection Is Associated with an Increased Risk of Venous Thromboembolism Following Revision Total Knee Replacement: An Analysis of Administrative Discharge Data

Alterations in coagulation profile of patients with periprosthetic joint infections

PURPOSE

This study aims to evaluate changes in the coagulation profile of patients with knee periprosthetic infections (PJI) and determine its diagnostic value in this complication.

METHODS

A prospective study was conducted with 112 patients who underwent revision surgery for total knee arthroplasty in a single tertiary hospital between January 2021 and December 2022.

RESULTS

51 patients were diagnosed with PJI. D-dimer (p = 0.001), fibrinogen (p = 0.0007), platelets (0.01), and international normalized ratio (p = 0.01) were significantly higher in patients with PJI.

CONCLUSIONS

Patients with PJI display altered coagulation profile. The evaluation of coagulation-related markers has limited value for diagnosing PJI. Further studies are needed to understand the impact of such alterations on patients' outcomes.

Risk Factors of In-Hospital Venous Thromboembolism and Prognosis After Emergent Ventral Hernia Repair

Background: The risk factors and association of venous thromboembolism (VTE) following emergent ventral hernia repair (EVHR) remains uncertain. This aim of the study aims was to establish the predictors of VTE after EVHR and its influence on the long-term outcomes. Methods: A total of 2093 patients from the MIMIC-IV database who underwent EVHR were recruited. Multivariate logistic regression and nomogram models were developed to predict in-hospital VTE and mortality. Calibration and receiver operating characteristic (ROC) curves were utilized to assess the model's effectiveness and reliability. Decision curve analysis (DCA) was performed to evaluate the net clinical benefits of the model. Results: The rate of in-hospital VTE was 1.6% (33/2093) after EVHR. Four independent potential factors were established after multivariate analysis, and the abovementioned risk factors fit into the nomogram. The prediction model presented good performance metrics (C-index: 0.857), the calibration and ROC curves demonstrated the accurate prediction power, and DCA indicated the superior net benefit of the established model. In-hospital and 1-year mortality rates were 0.8% (17/2093) and 4.1% (86/2076) after EVHR. The potential factors were included in the mortality prediction nomogram. The prediction model presented good performance metrics (C-index of 0.957 and 0.828, respectively), the calibration and ROC curves were consistent with the actual results, and DCA indicated the superior net benefit of the established model. Conclusion: The nomogram, derived from the logistic regression model, demonstrated excellent predictive performance for VTE occurrence and prognosis in patients following EVHR. This model could serve as a valuable reference for clinical decision-making regarding VTE prevention and for enhancing post-EVHR prognosis.

Efficacy and safety of postoperative single-dose anticoagulant treatment in preventing venous thromboembolism after revision hip arthroplasty: a retrospective cohort study

PURPOSE

The purpose of the study is to determine the efficacy and safety of postoperative single-dose anticoagulant treatment in preventing venous thromboembolism (VTE) after revision THA, in comparison with a multiple-dose chemoprophylaxis protocol.

METHODS

We retrospectively compared 295 patients undergoing revision THA who received multiple-dose chemoprophylaxis protocol (40 mg low-molecular-weight heparin once and oral rivaroxaban for 10 days) or single-dose chemoprophylaxis protocol (40 mg low-molecular-weight heparin once) for VTE. The patients in both groups performed active lower limb exercises. Each group was further stratified into subgroups based on the aetiology of revision. The incidence of VTE, wound complications within three months, hidden blood loss (HBL), transfusion rate, and surgical drainage duration were recorded.

RESULTS

The incidence rates of VTE (P = 0.870) did not differ between the two prophylaxis protocols. However, significant differences were observed in wound complications within three months (P = 0.002), HBL (P = 0.015), transfusion rate (P = 0.028). Surgical drainage duration was also shorter in the single-dose chemoprophylaxis group (P = 0.0023). In the subgroup analysis, the use of single-dose chemoprophylaxis protocol cannot significantly reduce HBL and transfusion rate after septic revision THA. The use of multiple-dose chemoprophylaxis protocol (OR = 2.89, P = 0.002) and high BMI (OR = 1.09, P = 0.037) were independent risk factors of wound complications.

CONCLUSIONS

Single-dose chemoprophylaxis protocol effectively and safely prevented VTE after revision THA compared with multiple-dose chemoprophylaxis protocol. The effect in reducing HBL and postoperative transfusion rate was limited in septic revision.

A mapping review on preoperative prognostic factors and outcome measures of revision total knee arthroplasty

To map literature on prognostic factors related to outcomes of revision total knee arthroplasty (rTKA), to identify extensively studied factors and to guide future research into what domains need further exploration. We performed a systematic literature search in MEDLINE, Embase, and Web of Science. The search string included multiple synonyms of the following keywords: "revision TKA", "outcome" and "prognostic factor". We searched for studies assessing the association between at least one prognostic factor and at least one outcome measure after rTKA surgery. Data on sample size, study design, prognostic factors, outcomes, and the direction of the association was extracted and included in an evidence map. After screening of 5,660 articles, we included 166 studies reporting prognostic factors for outcomes after rTKA, with a median sample size of 319 patients (30 to 303,867). Overall, 50% of the studies reported prospectively collected data, and 61% of the studies were performed in a single centre. In some studies, multiple associations were reported; 180 different prognostic factors were reported in these studies. The three most frequently studied prognostic factors were reason for revision (213 times), sex (125 times), and BMI (117 times). Studies focusing on functional scores and patient-reported outcome measures as prognostic factor for the outcome after surgery were limited (n = 42). The studies reported 154 different outcomes. The most commonly reported outcomes after rTKA were: re-revision (155 times), readmission (88 times), and reinfection (85 times). Only five studies included costs as outcome. Outcomes and prognostic factors that are routinely registered as part of clinical practice (e.g. BMI, sex, complications) or in (inter)national registries are studied frequently. Studies on prognostic factors, such as functional and sociodemographic status, and outcomes as healthcare costs, cognitive and mental function, and psychosocial impact are scarce, while they have been shown to be important for patients with osteoarthritis.

Reactive Thrombocytosis Leading to Recurrent Arterial Thrombosis Reversed by Management of a Prosthetic Joint Infection of the Hip

Prosthetic joint infections (PJIs) still pose a severe challenge for patients and the overall health care system. Infection, and PJI in particular, is a known cause of reactive thrombocytosis. Thromboembolic complications secondary to reactive thrombocytosis are infrequent and arterial thromboses are rarely described. We present the case of a 64-year-old female with reactive thrombosis and recurrent arterial thrombosis due to bilateral streptococcal PJI of the hip. Multiple episodes of acute ischemia of the right lower limb ultimately led to transfemoral amputation. Only after bilateral irrigation and debridement for infection control did the thrombocytosis resolve without any further thromboembolic complications. Early recognition of thrombocytosis, use of anti-platelet agents and early surgical treatment of the underlying infection (even when a conservative treatment may otherwise be considered) could have avoided this potentially life-threatening complication.