Advertisement

Concurrent Hardware Removal is Associated With Increased Odds of Infection Following Conversion Total Knee Arthroplasty

Published:October 25, 2022DOI:https://doi.org/10.1016/j.arth.2022.10.029

      Abstract

      Background

      The optimal timing of removal of periarticular implants prior to conversion total knee arthroplasty (TKA) remains to be determined. The purpose of this study was to compare infection rates in conversion TKA when hardware removal was performed in either a staged or concurrent manner.

      Methods

      We performed a retrospective study using a national insurance claims database of patients who underwent removal of hardware on the same day or within 1 year before their TKA. A total of 16,099 patients met the criteria. After matching, both final cohorts consisted of 4,502 patients. The 90-day and 1-year rates of prosthetic joint infection were calculated.

      Results

      The rates of infection were 1.64% and 3.00% in the staged group and 2.62% and 3.95% in the concurrent group at 90 days and 1 year postoperatively, respectively (P = .001, P = .01). Logistic regression analyses demonstrated that patients who had hardware removal greater than 3 months prior to TKA had significantly lower odds of infection at 1-year postop (Odds Ratio 0.61 95% Confidence Interval 0.45-0.84; P = .003).

      Conclusion

      Removal of hardware performed concurrently or within 3 months of a TKA is associated with increased odds of prosthetic joint infection at 1 year postoperatively. Surgeons should consider removing periarticular hardware prior to TKA when possible.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The Journal of Arthroplasty
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Kurtz S.
        • Ong K.
        • Lau E.
        • Mowat F.
        • Halpern M.
        Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030.
        J Bone Joint Surg Am. 2007; 89: 780-785https://doi.org/10.2106/JBJS.F.00222
        • Ramamurti P.
        • Fassihi S.C.
        • Stake S.
        • Stadecker M.
        • Whiting Z.
        • Thakkar S.C.
        Conversion total knee arthroplasty.
        JBJS Rev. 2021; 9https://doi.org/10.2106/JBJS.RVW.20.00198
        • Bergen M.A.
        • Ryan S.P.
        • Hong C.S.
        • Bolognesi M.P.
        • Seyler T.M.
        Conversion total knee arthroplasty: a distinct surgical procedure with increased resource utilization.
        J Arthroplasty. 2019; 34: S114-S120https://doi.org/10.1016/j.arth.2019.01.070
        • Smith E.J.
        • Katakam A.
        • Box H.N.
        • Healy W.L.
        • Bedair H.S.
        • Melnic C.M.
        Staged vs concurrent hardware removal during conversion total knee arthroplasty.
        J Arthroplasty. 2020; 35: 3569-3574https://doi.org/10.1016/j.arth.2020.06.055
        • Suzuki G.
        • Saito S.
        • Ishii T.
        • Motojima S.
        • Tokuhashi Y.
        • Ryu J.
        Previous fracture surgery is a major risk factor of infection after total knee arthroplasty.
        Knee Surg Sports Traumatol Arthrosc. 2011; 19: 2040-2044https://doi.org/10.1007/s00167-011-1525-x
        • Kreitz T.M.
        • Deirmengian C.A.
        • Penny G.S.
        • Maltenfort M.G.
        • Deirmengian G.K.
        A current procedural terminology code for “knee conversion” is needed to account for the additional surgical time required compared to total knee arthroplasty.
        J Arthroplasty. 2017; 32: 20-23https://doi.org/10.1016/j.arth.2016.06.040
        • Ge D.H.
        • Anoushiravani A.A.
        • Kester B.S.
        • Vigdorchik J.M.
        • Schwarzkopf R.
        Preoperative diagnosis can predict conversion total knee arthroplasty outcomes.
        J Arthroplasty. 2018; 33: 124-129.e1https://doi.org/10.1016/j.arth.2017.08.019
        • Lunebourg A.
        • Parratte S.
        • Gay A.
        • Ollivier M.
        • Garcia-Parra K.
        • Argenson J.-N.
        Lower function, quality of life, and survival rate after total knee arthroplasty for posttraumatic arthritis than for primary arthritis.
        Acta Orthop. 2015; 86: 189-194https://doi.org/10.3109/17453674.2014.979723
        • Song S.J.
        • Bae D.K.
        • Kim K.I.
        • Lee C.H.
        Conversion total knee arthroplasty after failed high tibial osteotomy.
        Knee Surg Relat Res. 2016; 28: 89-98https://doi.org/10.5792/ksrr.2016.28.2.89
        • Papasoulis E.
        • Patzakis M.J.
        • Zalavras C.G.
        Antibiotics in the treatment of low-velocity gunshot-induced fractures: a systematic literature review.
        Clin Orthop Relat Res. 2013; 471: 3937-3944https://doi.org/10.1007/s11999-013-2884-z
        • Manrique J.
        • Rasouli M.R.
        • Restrepo C.
        • Maltenfort M.G.
        • Beri J.
        • Oliver J.
        • et al.
        Total knee arthroplasty in patients with retention of prior hardware material: what is the outcome?.
        Arch Bone Jt Surg. 2018; 6: 23-26
        • Frisch N.B.
        • Keating T.C.
        • Calkins T.E.
        • Culvern C.N.
        • Della Valle C.J.
        Conversion total knee arthroplasty: prior fracture or osteotomy around the knee leads to increased resource utilization.
        J Arthroplasty. 2020; 35: 3563-3568https://doi.org/10.1016/j.arth.2020.06.050
        • Yayac M.F.
        • Harrer S.L.
        • Deirmengian G.K.
        • Parvizi J.
        • Courtney P.M.
        Conversion total knee arthroplasty is associated with increased post-acute care costs.
        J Arthroplasty. 2019; 34: 2855-2860https://doi.org/10.1016/j.arth.2019.06.059
        • Quan T.
        • Wang K.Y.
        • Gu A.
        • Gioia C.
        • Malahias M.-A.
        • Stoll W.T.
        • et al.
        Conversion total knee arthroplasty: a case complexity between primary and revision total knee arthroplasty.
        Knee. 2021; 31: 180-187https://doi.org/10.1016/j.knee.2021.06.008
        • Lizaur-Utrilla A.
        • Collados-Maestre I.
        • Miralles-Muñoz F.A.
        • Lopez-Prats F.A.
        Total knee arthroplasty for osteoarthritis secondary to fracture of the tibial plateau. A prospective matched cohort study.
        J Arthroplasty. 2015; 30: 1328-1332https://doi.org/10.1016/j.arth.2015.02.032
        • Klatte T.O.
        • Schneider M.M.
        • Citak M.
        • Oloughlin P.
        • Gebauer M.
        • Rueger M.
        • et al.
        Infection rates in patients undergoing primary knee arthroplasty with pre-existing orthopaedic fixation-devices.
        Knee. 2013; 20: 177-180https://doi.org/10.1016/j.knee.2013.02.004
        • Blanco J.F.
        • Díaz A.
        • Melchor F.R.
        • da Casa C.
        • Pescador D.
        Risk factors for periprosthetic joint infection after total knee arthroplasty.
        Arch Orthop Trauma Surg. 2020; 140: 239-245https://doi.org/10.1007/s00402-019-03304-6
        • Wu C.
        • Qu X.
        • Liu F.
        • Li H.
        • Mao Y.
        • Zhu Z.
        Risk factors for periprosthetic joint infection after total hip arthroplasty and total knee arthroplasty in Chinese patients.
        PLoS One. 2014; 9: e95300https://doi.org/10.1371/journal.pone.0095300
        • Everhart J.S.
        • Altneu E.
        • Calhoun J.H.
        Medical comorbidities are independent preoperative risk factors for surgical infection after total joint arthroplasty.
        Clin Orthop Relat Res. 2013; 471: 3112-3119https://doi.org/10.1007/s11999-013-2923-9
        • Jämsen E.
        • Nevalainen P.
        • Eskelinen A.
        • Huotari K.
        • Kalliovalkama J.
        • Moilanen T.
        Obesity, diabetes, and preoperative hyperglycemia as predictors of periprosthetic joint infection: a single-center analysis of 7181 primary hip and knee replacements for osteoarthritis.
        J Bone Joint Surg Am. 2012; 94: e101https://doi.org/10.2106/JBJS.J.01935
        • Jämsen E.
        • Nevalainen P.
        • Kalliovalkama J.
        • Moilanen T.
        Preoperative hyperglycemia predicts infected total knee replacement.
        Eur J Intern Med. 2010; 21: 196-201https://doi.org/10.1016/j.ejim.2010.02.006
        • Duchman K.R.
        • Gao Y.
        • Pugely A.J.
        • Martin C.T.
        • Noiseux N.O.
        • Callaghan J.J.
        The effect of smoking on short-term complications following total hip and knee arthroplasty.
        J Bone Joint Surg Am. 2015; 97: 1049-1058https://doi.org/10.2106/JBJS.N.01016
        • Kunutsor S.K.
        • Whitehouse M.R.
        • Blom A.W.
        • Beswick A.D.
        • INFORM Team
        Patient-related risk factors for periprosthetic joint infection after total joint arthroplasty: a systematic review and meta-analysis.
        PLoS One. 2016; 11: e0150866https://doi.org/10.1371/journal.pone.0150866
        • Gonzalez A.I.
        • Luime J.J.
        • Uçkay I.
        • Hannouche D.
        • Hoffmeyer P.
        • Lübbeke A.
        Is there an association between smoking status and prosthetic joint infection after primary total joint arthroplasty?.
        J Arthroplasty. 2018; 33: 2218-2224https://doi.org/10.1016/j.arth.2018.02.069
        • Daines B.K.
        • Dennis D.A.
        • Amann S.
        Infection prevention in total knee arthroplasty.
        J Am Acad Orthop Surg. 2015; 23: 356-364https://doi.org/10.5435/JAAOS-D-12-00170
        • Kong L.
        • Cao J.
        • Zhang Y.
        • Ding W.
        • Shen Y.
        Risk factors for periprosthetic joint infection following primary total hip or knee arthroplasty: a meta-analysis.
        Int Wound J. 2017; 14: 529-536https://doi.org/10.1111/iwj.12640