Artikel
Periprosthetic knee infection in octogenarians: A single institution experience at midterm outcome
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Autoren
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Christian Hipfl
- Charité – Universitätsmedizin Berlin, Centrum für Muskuloskeletale Chirurgie (CMSC), Klinik für Orthopädie, Berlin, Germany
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Daniel Karczewski
- Charité – Universitätsmedizin Berlin, Centrum für Muskuloskeletale Chirurgie (CMSC), Berlin, Germany
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Lukas Schönnagel
- Centrum für Muskuloskeletale Chirurgie, Berlin, Germany
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Doruk Akgün
- Charité – Universitätsmedizin Berlin, Centrum für Muskuloskeletale Chirurgie (CMSC), Berlin, Germany
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Carsten Perka
- Centrum für Muskuloskelatale Chirurgie, Charité Berlin, Berlin, Germany
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Sebastian Hardt
- Charité – Universitätsmedizin Berlin, Centrum für Muskuloskeletale Chirurgie (CMSC), Klinik für Orthopädie, Berlin, Germany
| Veröffentlicht: | 23. Oktober 2023 |
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Gliederung
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Objectives: Periprosthetic joint infections (PJI) of total knee arthroplasties (TKAs) in the elderly is among the clinically most challenging scenarios given multimorbidity combined with poor bone and soft tissue quality. Despite increasing prevalence, limited is known on PJI among this unique group of patients. As such, this study analyzed PJI characteristics, implant survivorship and non-surgical complications of octogenarians revised PJI for the knee.
Methods: We identified 31 patients that were revised for PJIs of the knee between 2010 and 2019 using a single universitybased registry. Mean age was 83 years (range 80–87), 48% were females, and mean BMI was 29 kg/m² . Mean age adjusted Charlson Comorbidity Index was 7, and mean ASA score was 3. Major causative pathogens included Coagulase-negative Staphylococci (26%), Staphylococcus aureus (13%), and Streptococci (13%). Two-stage exchange was performed in 30 patients, permanent resection arthroplasty in one joint. Kaplan-Meier survivorship analyses were performed. Mean followup was 4 years.
Results and conclusion: The 2-year survivorship free of any recurrent PJI was 96%, and there was one PJI relapse noted at 6 months. Moreover, there were three additional revisions for aseptic loosening, and one further revision for fracture. As such, the 2-year survivorship free of any revision was 87%. In addition to the aforementioned revisions, there was one additional plate osteosynthesis for a Vancouver C fracture, resulting in a 79% survivorship free of any reoperation at 2 years. Mean perioperative complication score according to the Clavien-Dindo classifcation was 2 out of 5. A total of three patients died: one patient 40 days after resection arthroplasty, two others 4 months and 8 months after reimplantation.
Octogenarians revised for PJI of the knee are at low risk of recurrent infection and overall revision at 2 years. However, moderate rates of perioperative complications and mortality at short term must acknowledge before deciding upon procedure.
