Reinfection after two-stage revision for periprosthetic infection of total knee arthroplasty
Identifieur interne : 004B85 ( Main/Exploration ); précédent : 004B84; suivant : 004B86Reinfection after two-stage revision for periprosthetic infection of total knee arthroplasty
Auteurs : Bernd Kubista [États-Unis, Autriche] ; Robert U. Hartzler [États-Unis] ; Christina M. Wood [États-Unis] ; Douglas R. Osmon [États-Unis] ; Arlen D. Hanssen [États-Unis] ; David G. Lewallen [États-Unis]Source :
- International Orthopaedics [ 0341-2695 ] ; 2011.
Descripteurs français
- KwdFr :
- Antibactériens (usage thérapeutique), Arthroplastie prothétique de genou (), Arthroplastie prothétique de genou (effets indésirables), Articulation du genou (), Articulation du genou (anatomopathologie), Articulation du genou (microbiologie), Enregistrements, Estimation de Kaplan-Meier, Humains, Infections dues aux prothèses (), Infections dues aux prothèses (diagnostic), Infections dues aux prothèses (étiologie), Inflammation (), Inflammation (diagnostic), Inflammation (étiologie), Maladie aigüe, Maladie chronique, Mâle, Pronostic, Prothèse de genou (effets indésirables), Récidive, Réintervention, Sujet âgé, Taux de survie, Échec thérapeutique, Études rétrospectives.
- MESH :
- anatomopathologie : Articulation du genou.
- diagnostic : Infections dues aux prothèses, Inflammation.
- effets indésirables : Arthroplastie prothétique de genou, Prothèse de genou.
- microbiologie : Articulation du genou.
- usage thérapeutique : Antibactériens.
- étiologie : Infections dues aux prothèses, Inflammation.
- Arthroplastie prothétique de genou, Articulation du genou, Enregistrements, Estimation de Kaplan-Meier, Humains, Infections dues aux prothèses, Inflammation, Maladie aigüe, Maladie chronique, Mâle, Pronostic, Récidive, Réintervention, Sujet âgé, Taux de survie, Échec thérapeutique, Études rétrospectives.
English descriptors
- KwdEn :
- Acute Disease, Aged, Anti-Bacterial Agents (therapeutic use), Arthroplasty, Replacement, Knee (adverse effects), Arthroplasty, Replacement, Knee (methods), Chronic Disease, Humans, Inflammation (diagnosis), Inflammation (etiology), Inflammation (therapy), Kaplan-Meier Estimate, Knee Joint (microbiology), Knee Joint (pathology), Knee Joint (surgery), Knee Prosthesis (adverse effects), Male, Prognosis, Prosthesis-Related Infections (diagnosis), Prosthesis-Related Infections (etiology), Prosthesis-Related Infections (therapy), Recurrence, Registries, Reoperation, Retrospective Studies, Survival Rate, Treatment Failure.
- MESH :
- chemical , therapeutic use : Anti-Bacterial Agents.
- adverse effects : Arthroplasty, Replacement, Knee, Knee Prosthesis.
- diagnosis : Inflammation, Prosthesis-Related Infections.
- etiology : Inflammation, Prosthesis-Related Infections.
- methods : Arthroplasty, Replacement, Knee.
- microbiology : Knee Joint.
- pathology : Knee Joint.
- surgery : Knee Joint.
- therapy : Inflammation, Prosthesis-Related Infections.
- Acute Disease, Aged, Chronic Disease, Humans, Kaplan-Meier Estimate, Male, Prognosis, Recurrence, Registries, Reoperation, Retrospective Studies, Survival Rate, Treatment Failure.
Abstract
Limited data exist regarding the long-term results or risk factors for failure after two-stage reimplantation for periprosthetic knee infection. The purpose of this retrospective review was to investigate infection-free implant survival and identify variables associated with reinfection after this procedure. Furthermore, a staging system was evaluated as a possible prognostic tool for patients undergoing two-stage reimplantation of infected total knee arthroplasty (TKA).
In this level II, retrospective prognostic study, 368 patients with infected TKA treated with a two-stage revision protocol at our institution between 1998 and 2006 were reviewed. Patients who developed recurrent infection and an equal number of patients randomly selected for the control group were analysed for risk factors associated with treatment failure.
At the most recent follow-up, 58 (15.8%) patients had developed reinfection after the two-stage reimplantation. The median time to reinfection was 1,303 days (3.6 years), with follow-up time ranging from six to 2,853 days (7.8 years). The strongest positive predictors of treatment failure included chronic lymphoedema [hazard ratio (HR) = 2.28, 95% confidence interval (CI) 1.16–4.48;
Our findings should be of help in counselling patients regarding their prognosis when faced with two-stage exchange for infected TKA and provide a basis for future comparisons.
Url:
DOI: 10.1007/s00264-011-1267-x
PubMed: 21553042
PubMed Central: 3251662
Affiliations:
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Le document en format XML
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Hartzler</name><affiliation wicri:level="2"><nlm:aff id="Aff1">Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN USA</nlm:aff><country>États-Unis</country><placeName><region type="state">Minnesota</region></placeName><wicri:cityArea>Department of Orthopedic Surgery, Mayo Clinic, Rochester</wicri:cityArea></affiliation></author><author><name sortKey="Wood, Christina M" sort="Wood, Christina M" uniqKey="Wood C" first="Christina M." last="Wood">Christina M. Wood</name><affiliation wicri:level="2"><nlm:aff id="Aff2">Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN USA</nlm:aff><country>États-Unis</country><placeName><region type="state">Minnesota</region></placeName><wicri:cityArea>Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester</wicri:cityArea></affiliation></author><author><name sortKey="Osmon, Douglas R" sort="Osmon, Douglas R" uniqKey="Osmon D" first="Douglas R." last="Osmon">Douglas R. Osmon</name><affiliation wicri:level="2"><nlm:aff id="Aff3">Division of Infectious Diseases, Mayo Clinic, Rochester, MN USA</nlm:aff><country>États-Unis</country><placeName><region type="state">Minnesota</region></placeName><wicri:cityArea>Division of Infectious Diseases, Mayo Clinic, Rochester</wicri:cityArea></affiliation></author><author><name sortKey="Hanssen, Arlen D" sort="Hanssen, Arlen D" uniqKey="Hanssen A" first="Arlen D." last="Hanssen">Arlen D. Hanssen</name><affiliation wicri:level="2"><nlm:aff id="Aff1">Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN USA</nlm:aff><country>États-Unis</country><placeName><region type="state">Minnesota</region></placeName><wicri:cityArea>Department of Orthopedic Surgery, Mayo Clinic, Rochester</wicri:cityArea></affiliation></author><author><name sortKey="Lewallen, David G" sort="Lewallen, David G" uniqKey="Lewallen D" first="David G." last="Lewallen">David G. Lewallen</name><affiliation wicri:level="2"><nlm:aff id="Aff1">Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN USA</nlm:aff><country>États-Unis</country><placeName><region type="state">Minnesota</region></placeName><wicri:cityArea>Department of Orthopedic Surgery, Mayo Clinic, Rochester</wicri:cityArea></affiliation></author></analytic><series><title level="j">International Orthopaedics</title><idno type="ISSN">0341-2695</idno><idno type="eISSN">1432-5195</idno><imprint><date when="2011">2011</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Acute Disease</term><term>Aged</term><term>Anti-Bacterial Agents (therapeutic use)</term><term>Arthroplasty, Replacement, Knee (adverse effects)</term><term>Arthroplasty, Replacement, Knee (methods)</term><term>Chronic Disease</term><term>Humans</term><term>Inflammation (diagnosis)</term><term>Inflammation (etiology)</term><term>Inflammation (therapy)</term><term>Kaplan-Meier Estimate</term><term>Knee Joint (microbiology)</term><term>Knee Joint (pathology)</term><term>Knee Joint (surgery)</term><term>Knee Prosthesis (adverse effects)</term><term>Male</term><term>Prognosis</term><term>Prosthesis-Related Infections (diagnosis)</term><term>Prosthesis-Related Infections (etiology)</term><term>Prosthesis-Related Infections (therapy)</term><term>Recurrence</term><term>Registries</term><term>Reoperation</term><term>Retrospective Studies</term><term>Survival Rate</term><term>Treatment Failure</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Antibactériens (usage thérapeutique)</term><term>Arthroplastie prothétique de genou ()</term><term>Arthroplastie prothétique de genou (effets indésirables)</term><term>Articulation du genou ()</term><term>Articulation du genou (anatomopathologie)</term><term>Articulation du genou (microbiologie)</term><term>Enregistrements</term><term>Estimation de Kaplan-Meier</term><term>Humains</term><term>Infections dues aux prothèses ()</term><term>Infections dues aux prothèses (diagnostic)</term><term>Infections dues aux prothèses (étiologie)</term><term>Inflammation ()</term><term>Inflammation (diagnostic)</term><term>Inflammation (étiologie)</term><term>Maladie aigüe</term><term>Maladie chronique</term><term>Mâle</term><term>Pronostic</term><term>Prothèse de genou (effets indésirables)</term><term>Récidive</term><term>Réintervention</term><term>Sujet âgé</term><term>Taux de survie</term><term>Échec thérapeutique</term><term>Études rétrospectives</term></keywords><keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Anti-Bacterial Agents</term></keywords><keywords scheme="MESH" qualifier="adverse effects" xml:lang="en"><term>Arthroplasty, Replacement, Knee</term><term>Knee Prosthesis</term></keywords><keywords scheme="MESH" qualifier="anatomopathologie" xml:lang="fr"><term>Articulation du genou</term></keywords><keywords scheme="MESH" qualifier="diagnosis" xml:lang="en"><term>Inflammation</term><term>Prosthesis-Related Infections</term></keywords><keywords scheme="MESH" qualifier="diagnostic" xml:lang="fr"><term>Infections dues aux prothèses</term><term>Inflammation</term></keywords><keywords scheme="MESH" qualifier="effets indésirables" xml:lang="fr"><term>Arthroplastie prothétique de genou</term><term>Prothèse de genou</term></keywords><keywords scheme="MESH" qualifier="etiology" xml:lang="en"><term>Inflammation</term><term>Prosthesis-Related Infections</term></keywords><keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>Arthroplasty, Replacement, Knee</term></keywords><keywords scheme="MESH" qualifier="microbiologie" xml:lang="fr"><term>Articulation du genou</term></keywords><keywords scheme="MESH" qualifier="microbiology" xml:lang="en"><term>Knee Joint</term></keywords><keywords scheme="MESH" qualifier="pathology" xml:lang="en"><term>Knee Joint</term></keywords><keywords scheme="MESH" qualifier="surgery" xml:lang="en"><term>Knee Joint</term></keywords><keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Inflammation</term><term>Prosthesis-Related Infections</term></keywords><keywords scheme="MESH" qualifier="usage thérapeutique" xml:lang="fr"><term>Antibactériens</term></keywords><keywords scheme="MESH" qualifier="étiologie" xml:lang="fr"><term>Infections dues aux prothèses</term><term>Inflammation</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Acute Disease</term><term>Aged</term><term>Chronic Disease</term><term>Humans</term><term>Kaplan-Meier Estimate</term><term>Male</term><term>Prognosis</term><term>Recurrence</term><term>Registries</term><term>Reoperation</term><term>Retrospective Studies</term><term>Survival Rate</term><term>Treatment Failure</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Arthroplastie prothétique de genou</term><term>Articulation du genou</term><term>Enregistrements</term><term>Estimation de Kaplan-Meier</term><term>Humains</term><term>Infections dues aux prothèses</term><term>Inflammation</term><term>Maladie aigüe</term><term>Maladie chronique</term><term>Mâle</term><term>Pronostic</term><term>Récidive</term><term>Réintervention</term><term>Sujet âgé</term><term>Taux de survie</term><term>Échec thérapeutique</term><term>Études rétrospectives</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Purpose</title><p>Limited data exist regarding the long-term results or risk factors for failure after two-stage reimplantation for periprosthetic knee infection. The purpose of this retrospective review was to investigate infection-free implant survival and identify variables associated with reinfection after this procedure. Furthermore, a staging system was evaluated as a possible prognostic tool for patients undergoing two-stage reimplantation of infected total knee arthroplasty (TKA).</p></sec><sec><title>Methods</title><p>In this level II, retrospective prognostic study, 368 patients with infected TKA treated with a two-stage revision protocol at our institution between 1998 and 2006 were reviewed. Patients who developed recurrent infection and an equal number of patients randomly selected for the control group were analysed for risk factors associated with treatment failure.</p></sec><sec><title>Results</title><p>At the most recent follow-up, 58 (15.8%) patients had developed reinfection after the two-stage reimplantation. The median time to reinfection was 1,303 days (3.6 years), with follow-up time ranging from six to 2,853 days (7.8 years). The strongest positive predictors of treatment failure included chronic lymphoedema [hazard ratio (HR) = 2.28, 95% confidence interval (CI) 1.16–4.48; <italic>p</italic> = 0.02),and revision between resection and definitive reimplantation (HR = 2.13, 95% CI 1.20–3.79; <italic>p</italic> = 0.01, whereas patients treated with intravenously administered Cefazolin had a significant reduction in recurrent infection rate (HR = 0.48, 95% CI 0.25–0.90; <italic>p</italic> = 0.02).</p></sec><sec><title>Conclusions</title><p>Our findings should be of help in counselling patients regarding their prognosis when faced with two-stage exchange for infected TKA and provide a basis for future comparisons.</p></sec></div></front></TEI><affiliations><list><country><li>Autriche</li><li>États-Unis</li></country><region><li>Minnesota</li><li>Vienne (Autriche)</li></region><settlement><li>Vienne (Autriche)</li></settlement></list><tree><country name="États-Unis"><region name="Minnesota"><name sortKey="Kubista, Bernd" sort="Kubista, Bernd" uniqKey="Kubista B" first="Bernd" last="Kubista">Bernd Kubista</name></region><name sortKey="Hanssen, Arlen D" sort="Hanssen, Arlen D" uniqKey="Hanssen A" first="Arlen D." last="Hanssen">Arlen D. Hanssen</name><name sortKey="Hartzler, Robert U" sort="Hartzler, Robert U" uniqKey="Hartzler R" first="Robert U." last="Hartzler">Robert U. Hartzler</name><name sortKey="Lewallen, David G" sort="Lewallen, David G" uniqKey="Lewallen D" first="David G." last="Lewallen">David G. Lewallen</name><name sortKey="Osmon, Douglas R" sort="Osmon, Douglas R" uniqKey="Osmon D" first="Douglas R." last="Osmon">Douglas R. Osmon</name><name sortKey="Wood, Christina M" sort="Wood, Christina M" uniqKey="Wood C" first="Christina M." last="Wood">Christina M. Wood</name></country><country name="Autriche"><region name="Vienne (Autriche)"><name sortKey="Kubista, Bernd" sort="Kubista, Bernd" uniqKey="Kubista B" first="Bernd" last="Kubista">Bernd Kubista</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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