High Mortality After Total Knee Arthroplasty Periprosthetic Joint Infection is Related to Preoperative Morbidity and the Disease Process but Not Treatment.

Autor: Drain NP; Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania., Bertolini DM; University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania., Anthony AW; University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania., Feroze MW; University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania., Chao R; University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania., Onyekweli T; University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania., Longo SE; University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania., Hersh BL; University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania., Smith CN; Department of Physical Therapy and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania., Rothenberger SD; Center for Research on Health Care Data Center, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania., Shah NB; Division of Infectious Disease, Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania., Urish KL; Arthritis and Arthroplasty Design Group, The Bone and Joint Center, Magee Womens Hospital of the University of Pittsburgh Medical Center; Department of Orthopaedic Surgery, Department of Bioengineering, and Clinical and Translational Science Institute, University of Pittsburgh; Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, Pennsylvania.
Jazyk: angličtina
Zdroj: The Journal of arthroplasty [J Arthroplasty] 2022 Jul; Vol. 37 (7), pp. 1383-1389. Date of Electronic Publication: 2022 Mar 18.
DOI: 10.1016/j.arth.2022.03.046
Abstrakt: Background: Periprosthetic joint infection (PJI) mortality rate is approximately 20%. The etiology for high mortality remains unknown. The objective of this study was to determine whether mortality was associated with preoperative morbidity (frailty), sequalae of treatment, or the PJI disease process itself.
Methods: A multicenter observational study was completed comparing 184 patients treated with septic revision total knee arthroplasty (TKA) to a control group of 38 patients treated with aseptic revision TKA. Primary outcomes included time and the cause of death. Secondary outcomes included preoperative comorbidities and Charlson Comorbidity Index (CCMI) measured preoperatively and at various postoperative timepoints.
Results: The septic revision TKA cohort experienced earlier mortality compared to the aseptic cohort, with a higher mortality rate at 90 days, 1, 2, and 3 years after index revision surgery (P = .01). There was no significant difference for any single cause of death (P > .05 for each). The mean preoperative CCMI was higher (P = .005) in the septic revision TKA cohort. Both septic and aseptic cohorts experienced a significant increase in CCMI from the preoperative to 3 years postoperative (P < .0001 and P = .002) and time of death (P < .0001 both) timepoints. The septic revision TKA cohort had a higher CCMI 3 years postoperatively (P = .001) and at time of death (P = .046), but not one year postoperatively (P = .119).
Conclusion: Compared to mortality from aseptic revision surgery, septic revision TKA is associated with earlier mortality, but there is no single specific etiology. As quantified by changes in CCMI, PJI mortality was associated with both frailty and the PJI disease process, but not treatment.
(Copyright © 2022 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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