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. 2021 Sep 15;103(18):1685-1693.
doi: 10.2106/JBJS.20.01678.

Outcomes of Primary Total Knee Arthroplasty Following Septic Arthritis of the Native Knee: A Case-Control Study

Jacob W Bettencourt  1 , Cody C Wyles  1 , Kristin M Fruth  2 , Douglas R Osmon  3 , Arlen D Hanssen  1 , Daniel J Berry  1 , Matthew P Abdel  1
Affiliations

Outcomes of Primary Total Knee Arthroplasty Following Septic Arthritis of the Native Knee: A Case-Control Study

Jacob W Bettencourt et al. J Bone Joint Surg Am. .

Abstract

Background: Septic arthritis of the native knee often results in irreversible joint damage leading to the need for total knee arthroplasty (TKA). The purpose of the present study was to examine the intermediate-term risk of periprosthetic joint infection (PJI), aseptic revision, and reoperation following primary TKA in patients with a history of septic arthritis of the native knee as compared with primary TKA performed for the treatment of osteoarthritis.

Methods: We retrospectively identified 215 primary TKAs performed from 1971 to 2016 at a single institution in patients with a history of septic arthritis of the native knee. Each case was matched 1:1 based on age, sex, body mass index (BMI), and surgical year to a TKA for osteoarthritis. The mean age and BMI were 63 years and 30 kg/m2, respectively. The mean duration of follow-up was 9 years.

Results: Survivorships free of PJI at 10 years were 90% and 99% for the septic arthritis and osteoarthritis groups, respectively (hazard ratio [HR] = 6.1; p < 0.01). Ten-year survivorships free of any aseptic revisions were 83% and 93% (HR = 2.5; p < 0.01), and survivorships free of any reoperation were 61% and 84% (HR = 2.9; p < 0.01) for the septic arthritis and osteoarthritis groups, respectively. In addition, as time from the diagnosis of native knee septic arthritis to TKA increased, the relative risk of subsequent infection decreased. Preoperative and 2-year postoperative Knee Society scores were similar between the groups (p = 0.16 and p = 0.19, respectively).

Conclusions: There was a 6.1-fold increased risk of PJI in patients undergoing TKA with a history of native knee septic arthritis when compared with controls undergoing TKA for the treatment of osteoarthritis, with a cumulative incidence of 9% at 10 years. Subgroup analysis of the septic arthritis cohort revealed a higher risk of any infection in patients who underwent TKA within the first 5 to 7 years after the diagnosis of septic arthritis as compared with those with a greater duration. Moreover, the 10-year rates of survival free of aseptic revision, any revision, and any reoperation were significantly worse in the native knee septic arthritis cohort.

Level of evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Conflict of interest statement

Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/G605).

References

    1. Lee GC, Pagnano MW, Hanssen AD. Total knee arthroplasty after prior bone or joint sepsis about the knee. Clin Orthop Relat Res. 2002 Nov;(404):226-31.
    1. Cooper C, Cawley MI. Bacterial arthritis in an English health district: a 10 year review. Ann Rheum Dis. 1986 Jun;45(6):458-63.
    1. Chen CM, Lin HH, Hung SC, Huang TF, Chen WM, Liu CL, Chen TH. Surgical treatment for septic arthritis of the knee joint in elderly patients: a 10-year retrospective clinical study. Orthopedics. 2013 Apr;36(4):e434-43.
    1. Ivey M, Clark R. Arthroscopic debridement of the knee for septic arthritis. Clin Orthop Relat Res. 1985 Oct;(199):201-6.
    1. Namba RS, Inacio MC, Paxton EW. Risk factors associated with deep surgical site infections after primary total knee arthroplasty: an analysis of 56,216 knees. J Bone Joint Surg Am. 2013 May 1;95(9):775-82.