Mortality During Total Knee Periprosthetic Joint Infection

Zachary C. Lum, Kyle M. Natsuhara, Trevor J. Shelton, Mauro Giordani, Gavin Caesar Pereira, John Meehan

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background: Periprosthetic joint infections (PJIs) are fraught with multiple complications including poor patient-reported outcomes, disability, reinfection, disarticulation, and even death. We sought to perform a systematic review asking the question: (1) What is the mortality rate of a PJI of the knee undergoing 2-stage revision for infection? (2) Has this rate improved over time? (3) How does this compare to a normal cohort of individuals? Methods: We performed a database search in MEDLINE/EMBASE, PubMed, and all relevant reference studies using the following keywords: “periprosthetic joint infection,” “mortality rates,” “total knee arthroplasty,” and “outcomes after two stage revision.” Two hundred forty-two relevant studies and citations were identified, and 14 studies were extracted and included in the review. Results: A total of 20,719 patients underwent 2-stage revision for total knee PJI. Average age was 66 years. Mean mortality percentage reported was 14.4% (1.7%-34.0%) with average follow-up 3.8 years (0.25-9 years). One-year mortality rate was 4.33% (3.14%-5.51%) after total knee PJI with an increase of 3.13% per year mortality thereafter (r = 0.76 [0.49, 0.90], P <.001). Five-year mortality was 21.64%. When comparing the national age-adjusted mortality (Actuarial Life Table) and the reported 1-year mortality risk in this meta-analysis, the risk of death after total knee PJI is significantly increased, with an odds ratio of 3.05 (95% confidence interval, 2.69-3.44; P <.001). Conclusion: The mortality rate after 2-stage total knee revision for infection is very high. When counseling a patient regarding complications of this disease, death should be discussed.

Original languageEnglish (US)
JournalJournal of Arthroplasty
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Knee Joint
Mortality
Infection
Joints
Disarticulation
Knee Replacement Arthroplasties
Life Tables
PubMed
MEDLINE
Meta-Analysis
Counseling
Knee
Odds Ratio
Databases
Confidence Intervals

Keywords

  • 2-stage revision arthroplasty
  • mortality after total knee arthroplasty periprosthetic joint infection
  • mortality in two stage total knee infection
  • periprosthetic joint infection mortality
  • revision total knee arthroplasty
  • total knee arthroplasty infection

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

Mortality During Total Knee Periprosthetic Joint Infection. / Lum, Zachary C.; Natsuhara, Kyle M.; Shelton, Trevor J.; Giordani, Mauro; Pereira, Gavin Caesar; Meehan, John.

In: Journal of Arthroplasty, 01.01.2018.

Research output: Contribution to journalArticle

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abstract = "Background: Periprosthetic joint infections (PJIs) are fraught with multiple complications including poor patient-reported outcomes, disability, reinfection, disarticulation, and even death. We sought to perform a systematic review asking the question: (1) What is the mortality rate of a PJI of the knee undergoing 2-stage revision for infection? (2) Has this rate improved over time? (3) How does this compare to a normal cohort of individuals? Methods: We performed a database search in MEDLINE/EMBASE, PubMed, and all relevant reference studies using the following keywords: “periprosthetic joint infection,” “mortality rates,” “total knee arthroplasty,” and “outcomes after two stage revision.” Two hundred forty-two relevant studies and citations were identified, and 14 studies were extracted and included in the review. Results: A total of 20,719 patients underwent 2-stage revision for total knee PJI. Average age was 66 years. Mean mortality percentage reported was 14.4{\%} (1.7{\%}-34.0{\%}) with average follow-up 3.8 years (0.25-9 years). One-year mortality rate was 4.33{\%} (3.14{\%}-5.51{\%}) after total knee PJI with an increase of 3.13{\%} per year mortality thereafter (r = 0.76 [0.49, 0.90], P <.001). Five-year mortality was 21.64{\%}. When comparing the national age-adjusted mortality (Actuarial Life Table) and the reported 1-year mortality risk in this meta-analysis, the risk of death after total knee PJI is significantly increased, with an odds ratio of 3.05 (95{\%} confidence interval, 2.69-3.44; P <.001). Conclusion: The mortality rate after 2-stage total knee revision for infection is very high. When counseling a patient regarding complications of this disease, death should be discussed.",
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author = "Lum, {Zachary C.} and Natsuhara, {Kyle M.} and Shelton, {Trevor J.} and Mauro Giordani and Pereira, {Gavin Caesar} and John Meehan",
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AU - Lum, Zachary C.

AU - Natsuhara, Kyle M.

AU - Shelton, Trevor J.

AU - Giordani, Mauro

AU - Pereira, Gavin Caesar

AU - Meehan, John

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N2 - Background: Periprosthetic joint infections (PJIs) are fraught with multiple complications including poor patient-reported outcomes, disability, reinfection, disarticulation, and even death. We sought to perform a systematic review asking the question: (1) What is the mortality rate of a PJI of the knee undergoing 2-stage revision for infection? (2) Has this rate improved over time? (3) How does this compare to a normal cohort of individuals? Methods: We performed a database search in MEDLINE/EMBASE, PubMed, and all relevant reference studies using the following keywords: “periprosthetic joint infection,” “mortality rates,” “total knee arthroplasty,” and “outcomes after two stage revision.” Two hundred forty-two relevant studies and citations were identified, and 14 studies were extracted and included in the review. Results: A total of 20,719 patients underwent 2-stage revision for total knee PJI. Average age was 66 years. Mean mortality percentage reported was 14.4% (1.7%-34.0%) with average follow-up 3.8 years (0.25-9 years). One-year mortality rate was 4.33% (3.14%-5.51%) after total knee PJI with an increase of 3.13% per year mortality thereafter (r = 0.76 [0.49, 0.90], P <.001). Five-year mortality was 21.64%. When comparing the national age-adjusted mortality (Actuarial Life Table) and the reported 1-year mortality risk in this meta-analysis, the risk of death after total knee PJI is significantly increased, with an odds ratio of 3.05 (95% confidence interval, 2.69-3.44; P <.001). Conclusion: The mortality rate after 2-stage total knee revision for infection is very high. When counseling a patient regarding complications of this disease, death should be discussed.

AB - Background: Periprosthetic joint infections (PJIs) are fraught with multiple complications including poor patient-reported outcomes, disability, reinfection, disarticulation, and even death. We sought to perform a systematic review asking the question: (1) What is the mortality rate of a PJI of the knee undergoing 2-stage revision for infection? (2) Has this rate improved over time? (3) How does this compare to a normal cohort of individuals? Methods: We performed a database search in MEDLINE/EMBASE, PubMed, and all relevant reference studies using the following keywords: “periprosthetic joint infection,” “mortality rates,” “total knee arthroplasty,” and “outcomes after two stage revision.” Two hundred forty-two relevant studies and citations were identified, and 14 studies were extracted and included in the review. Results: A total of 20,719 patients underwent 2-stage revision for total knee PJI. Average age was 66 years. Mean mortality percentage reported was 14.4% (1.7%-34.0%) with average follow-up 3.8 years (0.25-9 years). One-year mortality rate was 4.33% (3.14%-5.51%) after total knee PJI with an increase of 3.13% per year mortality thereafter (r = 0.76 [0.49, 0.90], P <.001). Five-year mortality was 21.64%. When comparing the national age-adjusted mortality (Actuarial Life Table) and the reported 1-year mortality risk in this meta-analysis, the risk of death after total knee PJI is significantly increased, with an odds ratio of 3.05 (95% confidence interval, 2.69-3.44; P <.001). Conclusion: The mortality rate after 2-stage total knee revision for infection is very high. When counseling a patient regarding complications of this disease, death should be discussed.

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