Early Infection Trends for Primary Total Knee Arthroplasty: A 5-Year Review

Abstract

The aim of this study was to track the annual rates and trends of overall, deep, and superficial surgical site infections (SSIs) following total knee arthroplasty using the most recent results from a large and nationwide database. A total of 197,192 cases were performed between 2012 and 2016 from a nationwide database stratified into years and based on superficial and/or deep SSIs. Cohorts were analyzed individually and then combined to evaluate overall SSI rates. The infection incidence for each year was calculated. After a 6-year correlation and trends analysis, univariate analyses were performed to compare the most recent year, 2016, with each of the preceding 4 years. Overall, there was a downward trend in overall SSI rates over the study period (2012–2016, with the lowest rate occurring in the most recent year, 2016 [0.11%]). Additionally, there was a decreasing trend for superficial SSI, with the lowest superficial SSI incidence occurring in 2016 (0.47%) and the greatest incidence occurring in 2012 (0.53%). An overall trend of decreasing SSI rates was observed nationwide over the 5-year period evaluated. A similar decreasing trend was also noted specifically for deep SSI rates, which can be potentially more complicated to manage, and result in decreased implant survivorship. The down trending SSI rates observed give potential credence to the value for newer and developing SSI preventative therapies as well as improved medical and surgical patient management. Nevertheless, there is still room for improvement, and continued efforts are needed to further lower SSIs after total knee arthroplasty.

Keywords

total knee arthroplasty - surgical site infection - trends - deep infection - superficial infection

Publication History

Received: 11 February 2020

Accepted: 31 May 2021

Article published online:
14 July 2021

• References

• 1 Gerberding J, Gaynes R, Horan T. et al. National Nosocomial Infections Surveillance (NNIS) system report, data summary from January 1992-April 2000, issued June 2000. Am J Infect Control 2000; 28 (06) 429-448
• 2 Mistry JB, Naqvi A, Chughtai M. et al. Decreasing the incidence of surgical-site infections after total joint arthroplasty. Am J Orthop 2017; 46 (06) E374-E387
• 3 Agodi A, Auxilia F, Barchitta M. et al; GISIO - Italian Study Group of Hospital Hygien. Risk of surgical site infections following hip and knee arthroplasty: results of the ISChIA-GISIO study. Ann Ig 2017; 29 (05) 422-430
• 4 Kurtz SM, Lau E, Schmier J, Ong KL, Zhao K, Parvizi J. Infection burden for hip and knee arthroplasty in the United States. J Arthroplasty 2008; 23 (07) 984-991
• 5 Kurtz SM, Lau E, Watson H, Schmier JK, Parvizi J. Economic burden of periprosthetic joint infection in the United States. J Arthroplasty 2012; 27 (08) 61-5.e1
• 6 Adeyemi A, Trueman P. Economic burden of surgical site infections within the episode of care following joint replacement. J Orthop Surg Res 2019; 14 (01) 196
• 7 de Lissovoy G, Fraeman K, Hutchins V, Murphy D, Song D, Vaughn BB. Surgical site infection: incidence and impact on hospital utilization and treatment costs. Am J Infect Control 2009; 37 (05) 387-397
• 8 Zhou Y, Li L, Zhou Q. et al. Lack of efficacy of prophylactic application of antibiotic-loaded bone cement for prevention of infection in primary total knee arthroplasty: results of a meta-analysis. Surg Infect (Larchmt) 2015; 16 (02) 183-187
• 9 Morrison TN, Chen AF, Taneja M, Küçükdurmaz F, Rothman RH, Parvizi J. Single vs repeat surgical skin preparations for reducing surgical site infection after total joint arthroplasty: a prospective, randomized, double-blinded study. J Arthroplasty 2016; 31 (06) 1289-1294
• 10 Pugely AJ, Martin CT, Gao Y, Schweizer ML, Callaghan JJ. The incidence of and risk factors for 30-day surgical site infections following primary and revision total joint arthroplasty. J Arthroplasty 2015; 30 (09) 47-50
• 11 Kapadia BH, Elmallah RK, Mont MAA. A randomized, clinical trial of preadmission chlorhexidine skin preparation for lower extremity total joint arthroplasty. J Arthroplasty 2016; 31 (12) 2856-2861
• 12 Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Guideline for prevention of surgical site infection, 1999. Am J Infect Control 1999; 27 (02) 97-132 , quiz 133–134, discussion 96
• 13 Berríos-Torres SI. Evidence-based update to the U.S. centers for disease control and prevention and healthcare infection control practices advisory committee guideline for the prevention of surgical site infection: developmental process. Surg Infect (Larchmt) 2016; 17 (02) 256-261
• 14 Springer BD, Cahue S, Etkin CD, Lewallen DG, McGrory BJ. Infection burden in total hip and knee arthroplasties: an international registry-based perspective. Arthroplast Today 2017; 3 (02) 137-140
• 15 Sodhi N, Anis HK, Garbarino LJ. et al. Have we actually reduced our 30-day short-term surgical site infection rates in primary total hip arthroplasty in the United States?. J Arthroplasty 2019; 34 (09) 2102-2106
• 16 Gold P, Garbarino LJ, Sodhi N. et al. Annual nationwide infection trends for revision total knee arthroplasty. J Knee Surg 2021; 34 (04) 378-382
• 17 Gold PA, Garbarino LJ, Sodhi N. et al. A 6-year trends analysis of infections after revision total hip arthroplasty. Ann Transl Med 2019; 7 (04) 76-76
• 18 Acuña AJ, Samuel LT, Karnuta JM, Sultan AA, Swiergosz AM, Kamath AF. What factors influence operative time in total knee arthroplasty?: A 10-year analysis in a national sample. J Arthroplasty 2020; 35 (03) 621-627
• 19 Choi HJ, Adiyani L, Sung J. et al; Korean Nosocomial Infections Surveillance System (KONIS). Five-year decreased incidence of surgical site infections following gastrectomy and prosthetic joint replacement surgery through active surveillance by the Korean Nosocomial Infection Surveillance System. J Hosp Infect 2016; 93 (04) 339-346
• 20 Wang F-D, Wang Y-P, Chen C-F, Chen H-P. The incidence rate, trend and microbiological aetiology of prosthetic joint infection after total knee arthroplasty: A 13 years' experience from a tertiary medical center in Taiwan. J Microbiol Immunol Infect 2018; 51 (06) 717-722