Periprosthetic knee infection reconstruction with a hinged prosthesis: Implant survival and risk factors for treatment failure

Michael Jian Wen Chen, Jui Fu Hung, Chih Hsiang Chang, Sheng Hsun Lee, Hsin Nung Shih, Yu Han Chang*

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

9 Scopus citations

Abstract

Background: Severe bone and soft tissue defects are common after failed two-stage exchange arthroplasty for periprosthetic joint infection (PJI). There is a paucity of evidence on the outcomes of using a hinged prosthesis for knee PJI reconstruction during second-stage re-implantation, especially regarding implant survivorship, reinfection risk factors, and functionality after successful reconstruction. Methods: A total of 58 knee PJI patients with Anderson Orthopaedic Research Institute (AORI) type II/III defect and soft tissue insufficiency underwent reconstruction with hinged prosthesis. Enrolled patients adhered to a two-stage exchange arthroplasty protocol and were evaluated for a mean follow up of 65.1 months. Kaplan–Meier analysis was conducted for implant survivorship and infection-free survival. Multivariate analysis was used to determine independent risk factors for recurrent infections. Knee Society Score (KSS) was used to evaluate functional outcomes. Results: The survivorship of hinged prosthesis was 86.2% at 2 years and 70.2% at 5 years. Infection-free analysis revealed an estimation of 68.9% at 2 years and 60.6% at 5 years. Of the 58 patients, 13 (22.4%) developed recurrent PJI, three (5.2%) aseptic loosening, and one (1.7%) periprosthetic fracture. Multivariate analysis revealed that obesity (hazard ratio (HR), 3.11), high-virulent pathogen (HR, 3.44), and polymicrobial infection (HR, 3.59) were independent risk factors for reinfection. Patients showed a mean improvement of 32.8 ± 7.7 in Knee Society Clinical Score (KSCS) and 30.8 ± 11.0 in Knee Society Function Score (KSFS) after successful reconstruction (P < 0.001). Conclusions: Using hinged knee prosthesis for PJI reconstruction provided an overall implant survival of 70.2% and an infection-free survival of 60.6% at mid-term follow up. Obesity, virulent pathogens, and polymicrobial infections were independent risk factors for infection recurrence.

Original languageEnglish
Pages (from-to)1035-1042
Number of pages8
JournalKnee
Volume27
Issue number3
DOIs
StatePublished - 06 2020
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2020

Keywords

  • Hinged prosthesis
  • Periprosthetic joint infection
  • Revision knee surgery
  • Two-stage exchange arthroplasty

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