Difficult primary total knee arthroplasty requiring a varus-valgus constrained implant is at higher risk of periprosthetic infection

Autor: Stefano Zaffagnini, Alberto Grassi, Maria Pia Neri, Cosimo Vasco, Mirco Lo Presti, Giuseppe Agrò, Sergio Cialdella, Marco Casali, Giuseppe Gianluca Costa
Přispěvatelé: Giuseppe Gianluca Costa, Mirco Lo Presti, Giuseppe Agrò, Cosimo Vasco, Sergio Cialdella, Maria Pia Neri, Alberto Grassi, Stefano Zaffagnini
Rok vydání: 2019
Předmět:
musculoskeletal diseases
Adult
Male
Reoperation
medicine.medical_specialty
Prosthesis-Related Infections
Knee Joint
medicine.medical_treatment
Periprosthetic
Kaplan-Meier Estimate
Prosthesis Design
Prosthesis
03 medical and health sciences
0302 clinical medicine
medicine
Humans
Orthopedics and Sports Medicine
Range of Motion
Articular
Arthroplasty
Replacement
Knee
Intraoperative Complications
Survival analysis
Aged
Retrospective Studies
Aged
80 and over
030222 orthopedics
biology
business.industry
Retrospective cohort study
030229 sport sciences
Middle Aged
biology.organism_classification
Total knee arthroplasty · Total knee replacement · Constrained total knee arthroplasty · Periprosthetic joint infection · Surgical time · Outcomes
Surgery
Valgus
Treatment Outcome
Cohort
Orthopedic surgery
Female
Range of motion
business
Knee Prosthesis
Zdroj: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA. 28(12)
ISSN: 1433-7347
Popis: The goal of this study was to compare the risk of periprosthetic infection of a consecutive cohort of primary varus–valgus constrained (VVC) total knee arthroplasties (TKAs), with a matched 1:1 cohort of primary posterior-stabilized (PS) TKAs. 74 primary VVC TKAs performed in 66 patients were identified and matched 1:1 with a cohort of 74 primary PS TKAs performed in 73 patients. At last follow up, patients were clinically evaluated using the Knee Society Score (KSS). Kaplan–Meier survival curves were generated to analyze survivorship using as endpoints revision for any reason, revision for periprosthetic infection and revision for mechanical failure after excluding periprosthetic infection. A multivariate logistic regression analysis was constructed to determine whether revision surgery for periprosthetic infection was influenced by patients’ gender, age, surgical time and reasons for TKA (primary vs secondary osteoarthritis). Demographic data were not significantly different between the two groups as regard patients’ age, gender, body mass index, Charlson Comorbidity Index, reasons for replacement, and length of follow-up. Surgical time was greater in the VVC group (95.7 ± 22.5 min vs 88.6 ± 17.1 min, respectively, p = 0.032). Postoperative KSS, range of motion and radiographic data did not differ significantly between the two groups. Overall revision rate and revision rate for mechanical failure after 5 years of follow-up was not statistically different between the two groups. Considering only the revision rate due to periprosthetic infection, the risk was higher in patients with primary VVC implants (p = 0.013). The surgical time was the only factor that significantly affected the risk of revision for periprosthetic infection (OR 1.0636, CI 95% 1.0209–1.1081, p = 0.0032), whereas patients’ gender, age and reason for TKA had no influence. Patients and surgeons should be aware of the higher risk of periprosthetic knee infection using a VVC prosthesis. However, the present study supports the use of VVC implants in cases of difficult knee replacements, since comparable clinical outcomes and overall revision rate was found after at least 5 years of follow up. Retrospective cohort study, Level III.
Databáze: OpenAIRE
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