Revision Total Knee Arthroplasty for Periprosthetic Joint Infection Is Associated With Increased Postoperative Morbidity and Mortality Relative to Noninfectious Revisions

Oct 17, 2017The Journal of arthroplasty

Revision Knee Replacement for Joint Infection Linked to Higher Risks of Complications and Death Compared to Non-Infection Revisions

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Abstract

17.2% of revision total knee arthroplasties (TKAs) were performed for periprosthetic joint infection (PJI).

Revision TKAs for PJI are associated with a significantly higher risk of major early postoperative complications, including death (adjusted odds ratio 3.25) and sepsis (odds ratio 8.73).
Patients undergoing revision for PJI have a higher likelihood of being discharged to nonhome settings (odds ratio 1.75) compared to those with aseptic revisions.
Readmission rates are greater for patients who had revision TKAs for PJI (odds ratio 1.67) compared to those with non-PJI revisions.
The average length of hospital stay is extended by 2.1 days for PJI revisions relative to non-PJI revisions.

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BACKGROUND: Periprosthetic joint infection (PJI) after primary total knee arthroplasty (TKA) is a devastating complication. The short-term morbidity profile of revision TKA performed for PJI relative to non-PJI revisions is poorly characterized. The purpose of this study is to determine 30-day postoperative outcomes after revision TKA for PJI, relative to primary TKA and aseptic revision TKA.

METHODS: The American College of Surgeons National Surgical Quality Improvement Program from 2005 to 2015 was queried for primary and revision TKA cases. Revision TKA cases were categorized into PJI and non-PJI cohorts. Differences in 30-day outcomes including postoperative complications, readmissions, operative time, and length of stay were compared using bivariate and multivariate analyses.

RESULTS: In total, 175,761 TKAs were included in this study, with 162,981 (92.7%) primary TKAs and 12,780 (7.3%) revision TKAs, of which 2196 (17.2%) revisions were performed for PJI. When compared to aseptic revision TKA, multivariate analysis demonstrated that PJI revisions had a significantly higher risk of major early postoperative complications including death (adjusted odds ratio [OR] 3.25) and sepsis (OR 8.73). In addition, nonhome discharge (OR 1.75), readmissions (OR 1.67), and length of stay (+2.1 days) were all greater relative to non-PJI revisions.

CONCLUSION: Utilizing a large, prospectively collected, national database, we found that revision TKA for PJI has a greater risk of short-term morbidity and mortality and requires a higher utilization of healthcare resources. These results have implications for patient counseling and alternative payment models that may eventually include revision TKA.

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Revision Total Knee Arthroplasty for Periprosthetic Joint Infection Is Associated With Increased Postoperative Morbidity and Mortality Relative to Noninfectious Revisions

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