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Meta-Analysis
. 2019 Aug 2;2(8):e199951.
doi: 10.1001/jamanetworkopen.2019.9951.

Prevalence of Deep Surgical Site Infection After Repair of Periarticular Knee Fractures: A Systematic Review and Meta-analysis

Grayson R Norris  1 , Jake X Checketts  2 , Jared T Scott  2   3 , Matt Vassar  2 , Brent L Norris  3   4 , Peter V Giannoudis  5
Affiliations
Meta-Analysis

Prevalence of Deep Surgical Site Infection After Repair of Periarticular Knee Fractures: A Systematic Review and Meta-analysis

Grayson R Norris et al. JAMA Netw Open. .

Erratum in

  • Error in Abstract and Methods.
    [No authors listed] [No authors listed] JAMA Netw Open. 2019 Oct 2;2(10):e1913513. doi: 10.1001/jamanetworkopen.2019.13513. JAMA Netw Open. 2019. PMID: 31577349 Free PMC article. No abstract available.

Abstract

Importance: Surgical management of periarticular knee fractures can be challenging, and adverse outcomes may be severe. Recent literature indicates that the rate of periarticular knee surgical site infection (SSI) may range from 2% to 88% depending on the fracture site.

Objective: To examine the prevalence of deep SSI and the rate of septic arthritis after surgical repair of fractures around the knee.

Data sources: The electronic databases MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched from their inception to July 1, 2018.

Study selection: Eligible studies had to specifically report deep SSI rates and include fractures in the distal femur, patella, tibial plateau, or proximal tibia. Risk factors that were associated with increased the risk of deep SSI were also examined.

Data extraction and synthesis: This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Data were extracted by multiple investigators. Comprehensive Meta-Analysis software was used for the pooling of data, using either random-effects or fixed-effects models, with respect to the degree of statistical heterogeneity present. Data analyses were conducted in October 2019.

Main outcomes and measures: The primary outcome was overall prevalence of deep SSI after periarticular knee fracture repair. The secondary outcomes were the overall prevalence of septic arthritis, risk factors associated with deep SSI, and the most commonly cultured bacteria specimens found periarticular knee infections.

Results: Of 6928 articles screened, 117 articles met inclusion criteria and were included in analysis. Among 11 432 patients included in analysis, 653 patients (5.7%) experienced deep SSIs, most commonly among patients with proximal tibia fractures (56 of 872 patients [6.4%]). Among studies that included information on septic arthritis, 38 of 1567 patients (2.4%) experienced septic arthritis. The 2 most commonly reported bacteria were methicillin-resistant Staphylococcus aureus, found in 67 SSIs, and methicillin-susceptible S aureus, found in 53 SSIs. Sixty-two studies (53.0%) in the sample received a Coleman Methodological Score of poor (<50 points).

Conclusions and relevance: Deep SSIs occurred in nearly 6% of periarticular knee fracture repairs, and 2.4% of SSIs were associated with septic arthritis. Surgeons managing these injuries should be vigilant when wounds are not pristine. Efforts should be made to elevate the quality of research conducted not only in this subject but also in orthopedic surgery as a whole.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Giannoudis reported grants from Zimmer Biomet and DePuy Synthes outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Flowchart of the Selection of Included Studies
Figure 2.
Figure 2.. Funnel Plot of Degree of Heterogeneity Within Selected Studies
Noticeable asymmetry can be attributed to the number of retrospective studies used.
Figure 3.
Figure 3.. Subset Analyses of Risk Factors Associated With Deep Surgical Site Infection (SSI)
Size of boxes indicates proportional weight of each trial. Diamonds indicate point estimates and 95% CIs of the combined result.
See this image and copyright information in PMC

References

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