Abstract
Background: Infected total knee arthroplasty causes significant morbidity to patients and also challenges to surgeons to provide a functional mobile knee joint.
Aim: Present a 10-year review (1997 to 2006) of all the revision total knee replacements performed for infection in our centre.
Methods and Materials: Data including the demographics, ASA grade, blood loss, blood transfusions, length of stay, laboratory investigations including culture and sensitivity of the deep swabs. The sensitivity and specificity of pre-operative CRP and ESR were related to culture results. Post operative complication was recorded. The financial implication of the whole treatment was calculated by applying the prescribed cost by the Voluntary health insurance limited.
Results: Revisions for suspected infection constituted 14.8% (28 out of 189 cases) of the total revision knee procedures performed during the period. All the patients underwent 2 staged revision knee Arthroplasty. The mean age was 68.6 (46–83 yrs). The mode for ASA grade was 2. The average blood loss was 2 litres and the mean blood transfusion units per case were 3.8 units. The average length of stay was 42.25 days, a 24.32 days longer than aseptic revisions.
46.4% of the cases had positive cultures from the deep tissues. Staphylococcus species were responsible for 62% of cases, while enterococci, pseudomonas, streptococcus pneumonia, and MRSA have similar occurrences. The mean total cost per case was € 21,895 (13,597 for aseptic revision) a 61% increase in cost for cases revised for non septic reasons.
Conclusion: Revision Total knee replacement for infection remains significantly more expensive than revision for aseptic loosening or other causes and provides a significant financial burden on orthopaedic services. Every precaution should be taken to avoid infection in total knee arthroplasty.
Correspondence should be addressed to Mr Richard Wallace at Musgrave Park Hospital, 20 Stockman’s Lane, Belfast BT9 7JB, Northern Ireland.
