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Ninety-day postoperative mortality and complications in continuous and unselected single-stage revisions for chronic periprosthetic joint infection

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Abstract

Purpose

Single-stage revision has gained significant attention as a major surgical approach for periprosthetic joint infection (PJI). However, the 90-day mortality and complication profile of single-stage revision is poorly characterized. The purposes of this study were to determine the incidence rates of and identify the risk factors for 90-day postoperative mortality and complications of single-stage revision for chronic PJI.

Methods

A retrospective review was conducted on patients who underwent single-stage revision for PJI between August 2000 and May 2022. Patient demographics, 90-day mortality, and postoperative complications were recorded. Complications were categorized into systemic and local complications. Patients in this study were further categorized into knee and hip revision groups. Univariate and multivariate logistic regression analyses were performed to identify significant independent predictors of the outcome measures.

Results

348 patients (144 knees and 204 hips) were included in this study. The 90-day mortality rate was 0.9%. The incidence rates of postoperative complications in knee and hip surgeries were 31.3% and 19.6%, respectively. The most common complication was deep-vein thrombosis (DVT). Rheumatoid arthritis (RA) was the independent predictor of mortality. In the knee revision group, fungal infection was identified as the independent predictor of recurrent PJI; regular alcohol use was predictive of wound dehiscence. Among hip PJI patients, age ≥ 80 years was independently associated with DVT; RA was found to be a predictor of dislocation and wound dehiscence.

Conclusion

For continuous and unselected patients with chronic PJI, single-stage revision demonstrated a satisfactory 90-day mortality. Nevertheless, the 90-day postoperative complication rates after single-stage revision in both knee and hip groups were relatively high.

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Data Availability

All relevant data are within the manuscript and its Additional files.

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Authors and Affiliations

  1. Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, 137 South LiYuShan Road, Urumqi, 830054, Xinjiang, China

    Chenchen Yang, Baochao Ji, Guoqing Li, Xiaogang Zhang, Boyong Xu & Li Cao

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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Chenchen Yang, Baochao Ji, Guoqing Li, Xiaogang Zhang, Boyong Xu, and Li Cao. The first draft of the manuscript was written by Chenchen Yang, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Li Cao.

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Ethics approval

This retrospective study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Human Investigation Committee (IRB) of First Affiliated Hospital of Xinjiang Medical University approved this study (20221102–1).

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Informed consent was obtained from all individual participants included in the study.

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According to Institutional Review Board, informed consent is not required since all information is anonymized and the submission does not include images that may identify the person.

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The authors declare no competing interests.

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Level of Evidence: Level III, therapeutic study

The first two authors (Chenchen Yang and Baochao Ji) contributed equally to this manuscript.

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Yang, C., Ji, B., Li, G. et al. Ninety-day postoperative mortality and complications in continuous and unselected single-stage revisions for chronic periprosthetic joint infection. International Orthopaedics (SICOT) (2024). https://doi.org/10.1007/s00264-024-06152-1

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