Trends in Revision Knee Arthroplasty for Prosthetic Joint Infection: A Single-Center Study of 384 Knees at a High-Volume Center between 2008 and 2021

BACKGROUND: Prosthetic joint infection (PJI) is one of the most devastating complications after total knee arthroplasty (TKA), and comorbidities increase the risk. We examined whether a temporal change has occurred in the demographics, especially regarding comorbidities, of patients who have PJI and were treated at our institution over a 13-year study period. In addition, we assessed the surgical methods used and the microbiology of the PJIs.

METHODS: Revisions (n=384, 377 patients) due to PJI of the knee performed at our institution between 2008 and September 2021 were identified. All included PJIs fulfilled the 2013 International Consensus Meeting diagnostic criteria. The surgeries were categorized into one of the following categories: debridement, antibiotics, and retention (DAIR), one-stage revision, and two-stage revision. Infections were classified as early, acute hematogenous, and chronic.

RESULTS: No changes in the median age of the patients nor comorbidity burden were observed during the study period. However, the proportion of two-stage revisions decreased remarkably from 57.6% in 2008 to 2009 to 6.3% in 2020 to 2021. A DAIR was the most used treatment strategy, but the proportion of one-stage revisions increased the most. In 2008 to 2009, 12.1% of the revisions were one-stage, but in 2020 to 2021, the proportion was 43.8%. The most common pathogen was Staphylococcus aureus (27.8%).

CONCLUSIONS: The comorbidity burden remained at the same level with no trends. A DAIR was the most used strategy, but the proportion of one-stage revisions rose to almost the same level. The incidence of PJI varied between the years, but remained relatively low.