Younger TKA Patients at Risk for Revision

One year after primary total knee arthroplasty, patients younger than 50 had a significantly higher risk of revision due to periprosthetic joint infection or to aseptic mechanical failure, according to result of this study.

Using the California Patient Discharge Database, researchers conducted a large population-based study with patients undergoing primary unilateral total knee arthroplasty (TKA) between 2005 and 2009.

Principle outcomes included partial or complete revision arthroplasty due to periprosthetic joint infection or due to aseptic mechanical failure within one year and researchers analyzed the effect of hospital TKA volume on the outcomes of infection and mechanical failure with use of hierarchical modeling.

At one year, researchers found 983 of 120,538 primary TKAs had undergone revision due to peri-prosthetic joint infection and 1,385 had undergone revision due to aseptic mechanical failure. According to study results, the cumulative incidence for revision due to periprosthetic joint infection was 1.36 percent and 3.49 percent for revision due to aseptic mechanical failure among patients younger than 50 years. Compared with patients aged 65 years or older, risk of periprosthetic joint infection was 1.8 times higher and the risk of aseptic mechanical failure was 4.7 times higher among patients younger than 50. Researchers found the rate of revision due to infection at hospitals in which a mean of more than 200 TKAs were performed per year was lower than the expected value.

“The high incidence of early infections and mechanical failures warrants further investigation to determine which specific patient characteristics in this younger age group contribute to their higher risk,” the researchers wrote. “The finding of a lower incidence of periprosthetic joint infection at high-volume hospitals is consistent with previous studies and supports the concept of utilizing specialty hospitals and hospitals with specialized surgical services as a means to reduce complications.”