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Knee Fusion Versus Above Knee Amputation As Two Options to Deal With Knee Periprosthetic Joint Infection Publisher Pubmed



Hoveidaei AH1 ; Ghaseminejadraeini A2 ; Esmaeili S3 ; Movahedinia M4 ; Karbasi S5 ; Khonji MS6 ; Nwankwo BO1, 7 ; Shrestha A1 ; Conway JD1
Authors
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Authors Affiliations
  1. 1. International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD, United States
  2. 2. School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
  3. 3. Sina University Hospital, Tehran University of Medical Sciences, Tehran, Iran
  4. 4. Orthopedics Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  5. 5. Department of Medicine, Isfahan University of Medical Sciences (MUI), Isfahan, Iran
  6. 6. Bone and Joint Reconstruction Research Center, Iran University of Medical Sciences (IUMS), Tehran, Iran
  7. 7. Department of Orthopaedic Surgery and Rehabilitation, Howard University Hospital, Washington, DC, United States

Source: Archives of Orthopaedic and Trauma Surgery Published:2024


Abstract

Background: Periprosthetic joint infection (PJI) poses a significant challenge in total knee arthroplasty (TKA), with recurrence rates as high as 14–28%, leading to substantial morbidity and treatment costs. When conventional treatments fail, knee fusion and above-the-knee amputation (AKA) emerge as alternative options. Existing literature offers conflicting views on the efficacy and impact of knee fusion versus AKA with varied outcomes and limitations. Methods: This retrospective national study spanning 2010–2022 investigates Knee Fusion and AKA as options for addressing Knee PJI. Utilizing PearlDiver Patient Records Database, procedural, and reimbursement data on over 100 million individuals from all the US was evaluated. Readmission rates, costs, and complications of the mentioned procedures were assessed using ICD-9 and ICD-10 codes within a 90-day period and one-year post-operation. Statistical analyses, including chi-square tests and regression models, were conducted using integrated R software. Results: The study reveals a substantial escalation (p < 0.0001) in the proportion of patients opting for AKA compared to arthrodesis. While age as a demographic factor showed no significant difference, arthrodesis patients exhibited lower comorbidity scores (3.6 ± 2.9 vs. 4.6 ± 3.4, p < 0.001). Arthrodesis correlated with higher 90-day thromboembolism rates (9.2% vs. 7.3%, p < 0.001), blood transfusion requirements (23.2% vs. 14.4%, p < 0.001), and acute renal failure incidence (p = 0.008) but demonstrated lower rates of urinary tract infections (p = 0.047) and cerebrovascular accidents (p < 0.001). At 1 year, arthrodesis was associated with higher infection rates (38.7% vs. 36.4%, p < 0.001). Arthrodesis patients had significant increased 90-day and 1-year readmission rates and hospitalization costs ($12,732 vs. $18,826, p < 0.001). Conclusions: We found higher rates of 1-year thromboembolism, infection, acute renal failure, and readmission in the arthrodesis group. AKA patients had more sepsis and cerebrovascular accidents. A patient-centered conversation is best for persistent infections and failed revision TKA. Considering the patient’s quality of life, goals, and health status, this discussion should cover each procedure’s risks and complications. © The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2024.
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