National Decline in Knee Fusions Performed for Salvage of Chronic Periprosthetic Total Knee Infections

Abstract

AbstractThe primary purpose of this study was to study and compare rates of two salvage operations for patients with chronically infected total knee arthroplasties: (1) knee arthrodesis and (2) above knee amputation (AKA). An analysis was performed comparing the inpatient hospital characteristics and complications between the two procedures. Secondarily, we presented rates of all surgically treated periprosthetic total knee infections over a 6-year period. Using the Nationwide Inpatient Sample, we identified all patients with a periprosthetic infection (International Classification of Diseases, Ninth Revision [ICD-9] 996.66) from 2009 to 2014. Subsequently, we identified surgically treated total knee infections through the following ICD-9 codes: 00.80 (all component revision), 00.84 (liner exchange), 80.06 (removal of prosthesis), 84.17 (AKA), and 81.22 (knee fusion). From 2009 to 2014, the annual incidence of surgically treated total knee periprosthetic infections increased by 34.9% nationally, while the annual incidence of primary total knees increased by only 13.9%. Salvage operations (AKA and knee fusion) represented 5.8% of all surgically treated infections. The rate of knee fusions decreased from 1.9% of surgically treated infections in 2009 to 1.4% in 2014 (p < 0.05), while the rate of AKA stayed steady at 4.5% of cases over the 6-year period. Length of stay was significantly shorter in the knee fusion group (7.9 vs. 10.8 days, p < 0.05), but total hospital costs were higher (33,016 vs. 24,933, p < 0.05). In the multivariable adjusted model, patients undergoing knee fusion had significantly decreased odds of being discharged to skilled nursing facility (odds ratio: 0.42, 95% confidence interval: 0.31–0.58). The annual incidence of surgically treated periprosthetic total knee infections is increasing. The rate of knee arthrodesis for chronic periprosthetic total knee infections is decreasing. Reasons for this downward trend in knee fusions should be evaluated carefully as knee fusions have shown to have the potential advantage of improved mobility and decreased patient morbidity for chronic PJI. The level of evidence is III.