BACKGROUND: Studies have suggested that the success of 2-stage revision total knee arthroplasty (rTKA) may be compromised by a prior failed irrigation and debridement (I&D). The purpose of this study was to use 2 large state inpatient databases to compare the 2-stage rTKA failure rates for those patients with and without a prior I&D. METHODS: This retrospective, longitudinal study used inpatient discharge data from the State Inpatient Database of 2 states (California and New York) from 2005 to 2011. A combination of International Classification of Diseases, Ninth Revision, diagnosis and procedure codes was used to identify rTKA patients and compare failure rates for rTKA patients with and without prior I&D. The primary outcome was failure of the staged revision, which was defined as subsequent surgery due to infection within 4 years of the 2-stage rTKA. RESULTS: Of the 750 patients who underwent 2-stage rTKA, 57 had undergone a prior I&D. In all, 126 patients failed rTKA. After 4 years, the estimated failure rate was 8.7% (95% confidence interval [CI], 1.9%-16.9%) in the group with prior I&D and 17.5% (95% CI, 14.7%-20.4%) in the group without prior I&D. After adjusting for sex, race, insurance, median household income, and comorbidities, the hazard ratio for the group with a failed I&D was 0.49 (P = .122; 95% CI, 0.20-1.20), which indicated a lower risk of failure compared to the group without prior I&D. CONCLUSION: These findings indicate that the failure rate of 2-stage rTKA is not increased by prior failed I&D.
BACKGROUND: Studies have suggested that the success of 2-stage revision total knee arthroplasty (rTKA) may be compromised by a prior failed irrigation and debridement (I&D). The purpose of this study was to use 2 large state inpatient databases to compare the 2-stage rTKA failure rates for those patients with and without a prior I&D. METHODS: This retrospective, longitudinal study used inpatient discharge data from the State Inpatient Database of 2 states (California and New York) from 2005 to 2011. A combination of International Classification of Diseases, Ninth Revision, diagnosis and procedure codes was used to identify rTKA patients and compare failure rates for rTKA patients with and without prior I&D. The primary outcome was failure of the staged revision, which was defined as subsequent surgery due to infection within 4 years of the 2-stage rTKA. RESULTS: Of the 750 patients who underwent 2-stage rTKA, 57 had undergone a prior I&D. In all, 126 patients failed rTKA. After 4 years, the estimated failure rate was 8.7% (95% confidence interval [CI], 1.9%-16.9%) in the group with prior I&D and 17.5% (95% CI, 14.7%-20.4%) in the group without prior I&D. After adjusting for sex, race, insurance, median household income, and comorbidities, the hazard ratio for the group with a failed I&D was 0.49 (P = .122; 95% CI, 0.20-1.20), which indicated a lower risk of failure compared to the group without prior I&D. CONCLUSION: These findings indicate that the failure rate of 2-stage rTKA is not increased by prior failed I&D.
Authors: Susan M Odum; Thomas K Fehring; Adolph V Lombardi; Ben M Zmistowski; Nicholas M Brown; Jeffrey T Luna; Keith A Fehring; Erik N Hansen Journal: J Arthroplasty Date: 2011-05-31 Impact factor: 4.757
Authors: Bernd Kubista; Robert U Hartzler; Christina M Wood; Douglas R Osmon; Arlen D Hanssen; David G Lewallen Journal: Int Orthop Date: 2011-05-07 Impact factor: 3.075
Authors: Thomas Bradbury; Thomas K Fehring; Michael Taunton; Arlen Hanssen; Khalid Azzam; Javad Parvizi; Susan M Odum Journal: J Arthroplasty Date: 2009-06-24 Impact factor: 4.757
Authors: Carl Deirmengian; Jordan Greenbaum; John Stern; Michael Braffman; Paul A Lotke; Robert E Booth; Jess H Lonner Journal: Clin Orthop Relat Res Date: 2003-11 Impact factor: 4.176
Authors: Si Young Song; Stuart B Goodman; Gina Suh; Andrea K Finlay; James I Huddleston; William J Maloney; Derek F Amanatullah Journal: Clin Orthop Relat Res Date: 2018-10 Impact factor: 4.176
Authors: Joseph J Kavolus; Daniel J Cunningham; Nima Eftekhary; Nicholas T Ting; William L Griffin; Thomas K Fehring Journal: Arthroplast Today Date: 2020-09-06