Possible Risk Factors for Severe Complications Occurring after Primary Total Knee Arthroplasty

Objective Total knee arthroplasty is one of the most common orthopedic surgeries.Readmission due to severe complications after total knee arthroplasty is a grave concern to surgeons.In this study,we evaluated the risk factors for severe complications after primary total knee arthroplasty.Methods We retrospectively collected clinical data of 2,974 patients who underwent primary total knee arthroplasty from July 2013 to June 2019 in our hospital.Postoperative complication≥gradeⅢwas defined as severe complication according to Clavien-Dindo classification system.Binary logistic regression was used to identify the predictive risk factors for severe complications.Results The complication rate after primary total knee arthroplasty was 6.8%and severe complication rate was 2.5%.Male(OR=2.178,95%CI:1.324-3.585,P=0.002),individuals above 75 years old(OR=1.936,95%CI:1.155-3.244,P=0.012),arrhythmia(OR=2.913,95%CI:1.350-6.285,P=0.006)and cerebrovascular disease(OR=2.804,95%CI:1.432-5.489,P=0.003)were predictive risk factors for severe complications after primary total knee arthroplasty.Conclusion Advanced age,male,arrhythmia,and cerebrovascular disease might be patients-related risk factors for postoperative severe complications after primary total knee arthroplasty.Special attention should be paid to patients with risk factors.

Comprehensive meta-analysis of antibiotic-impregnated bone cement versus plain bone cement in primary total knee arthroplasty for preventing periprosthetic joint infection

Purpose:Antibiotic-loaded bone cement(ALBC)was usually used to prevent periprosthetic joint infection(PJI)in primary total knee arthroplasty(PTKA),but whether to use ALBC or plain bone cement in PTKA remains unclear.We aimed to compare the occurrence rate of PJI using two different cements,and to investigate the efficacy of different antibiotic types and doses administered in preventing surgical site infection(SSI)with ALBC.Methods:The availability of ALBC for preventing PJI was evaluated by using a systematic review and meta-analysis referring to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Existing articles until December 2021 involving PTKA patients with both ALBC and plain bone cement cohorts were scanned by searching"total knee arthroplasty","antibiotic-loaded cement","antibiotic prophylaxis","antibiotic-impregnated cement"and"antibiotic-laden cement"in the database of PubMed/MEDLINE,Embase,Web of Science and the Cochrane Library.Subgroup analysis included the effectiveness of different antibiotic types and doses in preventing SSI with ALBC.The modified Jadad scale was employed to score the qualities of included articles.Results:Eleven quantitative studies were enrolled,including 34,159 knees undergoing PTKA.The meta-analysis results demonstrated that the use of prophylactic ALBC could significantly reduce the prevalence of deep incisional SSI after PTKA,whereas there was no significant reduction in the rate of superficial incisional SSI.Moreover,gentamicin-loaded cement was effective in preventing deep incisional SSI,and the use of high-dose ALBC significantly reduced the rate of deep incisional SSI after PTKA.Besides,no significant adverse reactions and complications were stated during the use of ALBC in PTKA.Conclusion:The preventive application of ALBC during PTKA could reduce the rates of deep PJI.Furthermore,bone cement containing gentamicin and high-dose ALBC could even better prevent deep infection after PTKA.However,the existing related articles are mostly single-center and retrospective studies,and further high-quality ones are needed for confirmation.