Luis Becker, Martin Resl, Alexander Grimberg, Yinan Wu, Clemens Gwinner, Carsten Perka
{"title":"Much higher re-revision rates and mortality following septic revision total knee arthroplasty compared to meta-analyses : a registry study.","authors":"Luis Becker, Martin Resl, Alexander Grimberg, Yinan Wu, Clemens Gwinner, Carsten Perka","doi":"10.1302/0301-620X.107B9.BJJ-2024-1440.R1","DOIUrl":null,"url":null,"abstract":"<p><strong>Aims: </strong>This study investigates re-revision and mortality rates following septic revision of total knee arthroplasty (TKA) using registry data from Germany.</p><p><strong>Methods: </strong>An observational cohort study was conducted using data from the German Arthroplasty Registry (EPRD), consisting of 15,372 revision TKAs. Cumulative incidences of re-revision and mortality for septic and aseptic revision-TKAs were analyzed over a seven-year follow-up (2015 to 2022). Kaplan-Meier estimates were employed to determine re-revision rates and cumulative mortality probabilities after revision TKA.</p><p><strong>Results: </strong>The re-revision rate within the first year following septic revision TKA was 21.7% (95% CI 20.3 to 23.1), compared to only 7.1% (95% CI 6.6 to 7.6) for aseptic revisions. Notably, 74% of all re-revisions for septic revision TKA occurred within the first year. Cumulative mortality within the first year after septic revision TKA was 4.9% (95% CI 4.2 to 5.7), rising to 28.5% (95% CI 24.2 to 33.2) after seven years. In contrast, aseptic revision TKA had lower mortality rates, with 2% within the first year and 16% within seven years. After multiple previous knee revisions, re-revision rates increased to over 47%, and mortality to 30% for septic revisions.</p><p><strong>Conclusion: </strong>Registry data revealed nearly twice the re-revision rates for septic revision TKA compared to single-centre studies, reflecting real-world outcomes in Germany. Septic revision TKA has a threefold higher re-revision rate in the first year and double the mortality rate compared to aseptic revisions. Given the high risk in the first postoperative year, optimizing perioperative procedures is crucial to reducing the burden of septic revision TKA.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 9","pages":"896-904"},"PeriodicalIF":4.6000,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Bone & Joint Journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1302/0301-620X.107B9.BJJ-2024-1440.R1","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
Abstract
Aims: This study investigates re-revision and mortality rates following septic revision of total knee arthroplasty (TKA) using registry data from Germany.
Methods: An observational cohort study was conducted using data from the German Arthroplasty Registry (EPRD), consisting of 15,372 revision TKAs. Cumulative incidences of re-revision and mortality for septic and aseptic revision-TKAs were analyzed over a seven-year follow-up (2015 to 2022). Kaplan-Meier estimates were employed to determine re-revision rates and cumulative mortality probabilities after revision TKA.
Results: The re-revision rate within the first year following septic revision TKA was 21.7% (95% CI 20.3 to 23.1), compared to only 7.1% (95% CI 6.6 to 7.6) for aseptic revisions. Notably, 74% of all re-revisions for septic revision TKA occurred within the first year. Cumulative mortality within the first year after septic revision TKA was 4.9% (95% CI 4.2 to 5.7), rising to 28.5% (95% CI 24.2 to 33.2) after seven years. In contrast, aseptic revision TKA had lower mortality rates, with 2% within the first year and 16% within seven years. After multiple previous knee revisions, re-revision rates increased to over 47%, and mortality to 30% for septic revisions.
Conclusion: Registry data revealed nearly twice the re-revision rates for septic revision TKA compared to single-centre studies, reflecting real-world outcomes in Germany. Septic revision TKA has a threefold higher re-revision rate in the first year and double the mortality rate compared to aseptic revisions. Given the high risk in the first postoperative year, optimizing perioperative procedures is crucial to reducing the burden of septic revision TKA.
目的：本研究利用德国的登记数据调查全膝关节置换术（TKA）脓毒性翻修后的再翻修和死亡率。方法：一项观察性队列研究使用来自德国关节成形术登记处（EPRD）的数据，包括15,372个修正tka。在7年的随访（2015年至2022年）中，分析了脓毒性和无菌性翻修- tka的累积再次翻修发生率和死亡率。Kaplan-Meier估计用于确定修订TKA后的重新修订率和累积死亡率概率。结果：脓毒性修订TKA后一年内的重新修订率为21.7% (95% CI 20.3至23.1)，而无菌修订仅为7.1% （95% CI 6.6至7.6）。值得注意的是，74%的脓毒性TKA患者在一年内进行了再次翻修。脓毒症改良TKA术后一年内的累积死亡率为4.9% (95% CI 4.2 ~ 5.7)， 7年后上升至28.5% （95% CI 24.2 ~ 33.2）。相比之下，无菌改良TKA的死亡率较低，第一年为2%，七年内为16%。在多次膝关节翻修后，再次翻修率增加到47%以上，脓毒性翻修的死亡率增加到30%。结论：注册数据显示，与单中心研究相比，脓毒症改良TKA的再修订率几乎是两倍，反映了德国的现实结果。脓毒性修订TKA在第一年的重新修订率是无菌修订的三倍，死亡率是无菌修订的两倍。鉴于脓毒症术后第一年的高风险，优化围手术期程序对于减轻脓毒症改良TKA的负担至关重要。
期刊介绍：
We welcome original articles from any part of the world. The papers are assessed by members of the Editorial Board and our international panel of expert reviewers, then either accepted for publication or rejected by the Editor. We receive over 2000 submissions each year and accept about 250 for publication, many after revisions recommended by the reviewers, editors or statistical advisers. A decision usually takes between six and eight weeks. Each paper is assessed by two reviewers with a special interest in the subject covered by the paper, and also by members of the editorial team. Controversial papers will be discussed at a full meeting of the Editorial Board. Publication is between four and six months after acceptance.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
