The impact of patient and surgical factors on the rate of infection after primary total knee arthroplasty: an analysis of 64,566 joints from the New Zealand Joint Registry.
AIMS
The aim of this study was to identify risk factors for prosthetic joint infection (PJI) following total knee arthroplasty (TKA).


PATIENTS AND METHODS
The New Zealand Joint Registry database was analysed, using revision surgery for PJI at six and 12 months after surgery as primary outcome measures. Statistical associations between revision for infection, with common and definable surgical and patient factors were tested.


RESULTS
A total of 64 566 primary TKAs have been recorded on the registry between 1999 and 2012 with minimum follow-up of 12 months. Multivariate analysis showed statistically significant associations with revision for PJI between male gender (odds ratio (OR) 1.85, 95% confidence interval (CI) 1.24 to 2.74), previous surgery (osteotomy (OR 2.45 95% CI 1.2 to 5.03), ligament reconstruction (OR 1.85, 95% CI 0.68 to 5.00)), the use of laminar flow (OR 1.6, 95% CI 1.04 to 2.47) and the use of antibiotic-laden cement (OR 1.93, 95% CI 1.19 to 3.13). There was a trend towards significance (p = 0.052) with the use of surgical helmet systems at six months (OR 1.53, 95% CI 1.00 to 2.34).


CONCLUSION
These findings show that patient factors remain the most important in terms of predicting early PJI following TKA. Furthermore, we found no evidence that modern surgical helmet systems reduce the risk of PJI and laminar flow systems may actually increase risk in TKA. The use of this registry data assists the estimation of the risk of PJI for individual patients, which is important for both informed consent and the interpretation of infection rates at different institutions.


TAKE HOME MESSAGE
Infection rates in TKA are related to both individual patient and surgical factors, and some modern methods of reducing infection may actually increase infection risk.
['Tayton|E R|ER|', 'Frampton|C|C|', 'Hooper|G J|GJ|', 'Young|S W|SW|']
D000368:Aged D000900:Anti-Bacterial Agents D019645:Arthroplasty, Replacement, Knee D016208:Databases, Factual D005260:Female D006801:Humans D007720:Knee Prosthesis D008297:Male D008875:Middle Aged D009520:New Zealand D011475:Prosthesis Failure D016459:Prosthesis-Related Infections D012042:Registries D012086:Reoperation D012307:Risk Factors
Infection Arthroplasty Risk Factors TKA Obesity. Total Knee Replacement