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Epidemiology of the Infected Total Knee Arthroplasty: Incidence, Causes, and the Burden of Disease

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The Infected Total Knee Arthroplasty

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Abstract

Periprosthetic joint infection (PJI) after total knee arthroplasty (TKA) is a severe complication. The purpose of this chapter is to review the incidence, causes, and burden of PJI after TKA. At 30 days, the overall rate of surgical site infection (SSI) is 1.1%, while the reported rate of deep infection is 0.1%. The lifetime incidence of PJI after TKA ranges from 0.7 to 4.6%. Many related and predisposing factors have been identified. These can be classified as preoperative, intraoperative, postoperative, and late infections. The preoperative factors are previous knee surgery, inflammatory arthritis, and the use of glucocorticoids and immunosuppressants. The intraoperative factors are prolonged surgical time, inadequate antibiotic prophylaxis, and intraoperative fractures. The postoperative factors are wound drainage for longer than 10 days, reoperation and deep venous thrombosis. Factors related to late infections include cutaneous infections, urinary tract infections, lower respiratory tract infections, abdominal infections, and generalized sepsis. Patients with PJIs have significantly longer hospitalizations (5.3 vs. 3 days), more readmissions (3.6 vs. 0.1), and more clinic visits (6.5 vs. 1.3) when compared to a matched control group. The mean annual cost is significantly higher in patients who have PJIs ($116,383 on average) when compared to the matched control group ($28,249 on average). Hospital costs are between 2- and 24-fold higher in patients with PJI than in those without PJI. PJIs following TKA represent a huge burden for the patient, for the surgeon, and for the health-care economy.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, “La Paz” University Hospital-IdiPaz, Paseo de la Castellana 261, 28046, Madrid, Spain

    E. Carlos Rodríguez-Merchán

  2. University College London Institute of Orthopaedics and Musculoskeletal Science, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK

    Alexander D. Liddle

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  1. E. Carlos Rodríguez-Merchán
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Correspondence to E. Carlos Rodríguez-Merchán .

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Editors and Affiliations

  1. Department of Orthopaedic Surgery, La Paz University Hospital, Madrid, Spain

    E. Carlos Rodríguez-Merchán

  2. University College London Hospitals , London, United Kingdom

    Sam Oussedik

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Rodríguez-Merchán, E.C., Liddle, A.D. (2018). Epidemiology of the Infected Total Knee Arthroplasty: Incidence, Causes, and the Burden of Disease. In: Rodríguez-Merchán, E., Oussedik, S. (eds) The Infected Total Knee Arthroplasty. Springer, Cham. https://doi.org/10.1007/978-3-319-66730-0_1

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  • DOI: https://doi.org/10.1007/978-3-319-66730-0_1

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