Medizinische Universität Graz - Research portal
Selected Publication:
Keusch, M.
Failed Arthroplasty: What should be done next
Humanmedizin; [ Diplomarbeit ] Medizinische Universität Graz; 2021. pp. 74
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- Authors Med Uni Graz:
- Advisor:
- Glehr Mathias
- Leitner Lukas
- Altmetrics:
- Abstract:
- Background Increasing total hip (THA) and knee (TKA) arthroplasty numbers and life expectation led to accumulation of failed arthroplasty situations (FA), where non-resolvable periprosthetic joint infection (PJI) must be accepted after several revision surgeries. Even in specialized centers, generally accepted recommendations for surgical and non-surgical treatment of those cases are often lacking. Methods For this retrospective clinical analysis, patients who had been treated with a salvage procedure for FA (Chronic fistula (CF), Girdlestone resection arthroplasty (GRA), arthrodesis, and/or amputation) following PJI after THA and TKA, at our PJI-specialized center between 2008-2018 were included in this thesis. Demographics, clinical data, follow-up (revision, conversion of the situation) and overall survival were collected. Individual FA treatments were analyzed and compared with regard to their complication and survival rate. Kaplan–Meier analysis were performed to identify predictors of revision and all- cause mortality for general populations and different FA treatments. Results 135 patients (m: 46.7%; TKA: 42.2 %; THA: 57.8%; 71.7 ± 12.9 years old at first diagnosis of PJI) were identified, surgical conversion to another FA during follow-up led to inclusion of 179 cases of FA situations (CF, 65.3%; GRA, 16.7%; amputation, 11.2%; arthrodesis, 6.7%). PJI had occurred 5.3 ± 7.5 years after primary arthroplasty, 3.8 ± 2.7 surgeries of the infected joint were performed until FA was established (THA: 3.0 ± 2.4; TKA: 4.9 ± 2.8; p<.001). 42.4% of patients died during our follow-up of 5.0 ± 3.7 years, in 44.1% of cases FA had to be revised, and 11.7% of cases could successfully be re-converted to infection free arthroplasty. Significant risk factors for surgical revision were high age (p=0.041), gram negative infection (p=0.044), infection with Pseudomonas spp. (p=0.023), fungal infection of surgery site (p=0.027), multiple microorganisms at the infection site (p=0.002) and high number of surgeries prior FA situation had to be established (p<0.001). Mortality of FA cases was, amongst others, significantly increased with higher age (p<0.001), ASA score >2 (p=0.002), diabetes (p=0.034) and renal insufficiency (p=.028). Discussion This first, close analysis of large FA cohorts revealed significant risk factors and might improve treatment decisions. FA risk for surgical revision mainly seems to be influenced by infection correlated factors, whilst mortality risk is mainly influenced by patient health correlated factors. Careful patient education prior treatment is mandatory.