Abstract：
BACKGROUND: Periprosthetic joint infection (PJI) poses a significant challenge in total knee arthroplasty (TKA), with recurrence rates as high as 14-28%, leading to substantial morbidity and treatment costs. When conventional treatments fail, knee fusion and above-the-knee amputation (AKA) emerge as alternative options. Existing literature offers conflicting views on the efficacy and impact of knee fusion versus AKA with varied outcomes and limitations.
METHODS: This retrospective national study spanning 2010-2022 investigates Knee Fusion and AKA as options for addressing Knee PJI. Utilizing PearlDiver Patient Records Database, procedural, and reimbursement data on over 100 million individuals from all the US was evaluated. Readmission rates, costs, and complications of the mentioned procedures were assessed using ICD-9 and ICD-10 codes within a 90-day period and one-year post-operation. Statistical analyses, including chi-square tests and regression models, were conducted using integrated R software.
RESULTS: The study reveals a substantial escalation (p < 0.0001) in the proportion of patients opting for AKA compared to arthrodesis. While age as a demographic factor showed no significant difference, arthrodesis patients exhibited lower comorbidity scores (3.6 ± 2.9 vs. 4.6 ± 3.4, p < 0.001). Arthrodesis correlated with higher 90-day thromboembolism rates (9.2% vs. 7.3%, p < 0.001), blood transfusion requirements (23.2% vs. 14.4%, p < 0.001), and acute renal failure incidence (p = 0.008) but demonstrated lower rates of urinary tract infections (p = 0.047) and cerebrovascular accidents (p < 0.001). At 1 year, arthrodesis was associated with higher infection rates (38.7% vs. 36.4%, p < 0.001). Arthrodesis patients had significant increased 90-day and 1-year readmission rates and hospitalization costs ($12,732 vs. $18,826, p < 0.001).
CONCLUSIONS: We found higher rates of 1-year thromboembolism, infection, acute renal failure, and readmission in the arthrodesis group. AKA patients had more sepsis and cerebrovascular accidents. A patient-centered conversation is best for persistent infections and failed revision TKA. Considering the patient\'s quality of life, goals, and health status, this discussion should cover each procedure\'s risks and complications.
METHODS: This retrospective national study spanning 2010-2022 investigates Knee Fusion and AKA as options for addressing Knee PJI. Utilizing PearlDiver Patient Records Database, procedural, and reimbursement data on over 100 million individuals from all the US was evaluated. Readmission rates, costs, and complications of the mentioned procedures were assessed using ICD-9 and ICD-10 codes within a 90-day period and one-year post-operation. Statistical analyses, including chi-square tests and regression models, were conducted using integrated R software.
RESULTS: The study reveals a substantial escalation (p < 0.0001) in the proportion of patients opting for AKA compared to arthrodesis. While age as a demographic factor showed no significant difference, arthrodesis patients exhibited lower comorbidity scores (3.6 ± 2.9 vs. 4.6 ± 3.4, p < 0.001). Arthrodesis correlated with higher 90-day thromboembolism rates (9.2% vs. 7.3%, p < 0.001), blood transfusion requirements (23.2% vs. 14.4%, p < 0.001), and acute renal failure incidence (p = 0.008) but demonstrated lower rates of urinary tract infections (p = 0.047) and cerebrovascular accidents (p < 0.001). At 1 year, arthrodesis was associated with higher infection rates (38.7% vs. 36.4%, p < 0.001). Arthrodesis patients had significant increased 90-day and 1-year readmission rates and hospitalization costs ($12,732 vs. $18,826, p < 0.001).
CONCLUSIONS: We found higher rates of 1-year thromboembolism, infection, acute renal failure, and readmission in the arthrodesis group. AKA patients had more sepsis and cerebrovascular accidents. A patient-centered conversation is best for persistent infections and failed revision TKA. Considering the patient\'s quality of life, goals, and health status, this discussion should cover each procedure\'s risks and complications.
摘要：
背景：假体周围感染（PJI）对全膝关节置换术（TKA）提出了重大挑战，复发率高达14-28%，导致大量的发病率和治疗费用。当常规治疗失败时，膝关节融合术和膝上截肢(AKA)作为替代选择出现.现有文献对膝关节融合术与AKA的疗效和影响存在不同的结果和局限性提出了相互矛盾的观点。
方法：这项2010-2022年的国家回顾性研究调查了膝关节融合术和AKA作为解决膝关节PJI的选择。利用PearlDiver患者记录数据库,程序,并评估了来自美国的1亿多人的报销数据。再入院率,成本,使用ICD-9和ICD-10代码在术后90天内和术后1年评估上述手术的并发症.统计分析，包括卡方检验和回归模型，使用集成的R软件进行。
结果：研究显示，与关节固定术相比，选择AKA的患者比例大幅上升（p<0.0001）。虽然年龄作为人口统计学因素没有显着差异，关节固定术患者的合并症评分较低(3.6±2.9vs.4.6±3.4，p<0.001)。关节固定术与更高的90天血栓栓塞率相关(9.2%vs.7.3%，p<0.001)，输血需求（23.2%vs.14.4%,p<0.001)，和急性肾功能衰竭发生率（p=0.008），但尿路感染（p=0.047）和脑血管意外（p<0.001）的发生率较低。在1年,关节固定术与较高的感染率相关(38.7%vs.36.4%,p<0.001)。关节融合术患者90天和1年的再入院率和住院费用显着增加（$12,732vs.18,826美元，p<0.001）。
结论：我们发现1年血栓栓塞的发生率更高，感染,急性肾功能衰竭,关节固定术组的再入院。AKA患者败血症和脑血管意外较多。以患者为中心的对话最适合持续感染和TKA翻修失败。考虑到病人的生活质量,目标,和健康状况，这个讨论应该包括每个程序的风险和并发症。
方法：这项2010-2022年的国家回顾性研究调查了膝关节融合术和AKA作为解决膝关节PJI的选择。利用PearlDiver患者记录数据库,程序,并评估了来自美国的1亿多人的报销数据。再入院率,成本,使用ICD-9和ICD-10代码在术后90天内和术后1年评估上述手术的并发症.统计分析，包括卡方检验和回归模型，使用集成的R软件进行。
结果：研究显示，与关节固定术相比，选择AKA的患者比例大幅上升（p<0.0001）。虽然年龄作为人口统计学因素没有显着差异，关节固定术患者的合并症评分较低(3.6±2.9vs.4.6±3.4，p<0.001)。关节固定术与更高的90天血栓栓塞率相关(9.2%vs.7.3%，p<0.001)，输血需求（23.2%vs.14.4%,p<0.001)，和急性肾功能衰竭发生率（p=0.008），但尿路感染（p=0.047）和脑血管意外（p<0.001）的发生率较低。在1年,关节固定术与较高的感染率相关(38.7%vs.36.4%,p<0.001)。关节融合术患者90天和1年的再入院率和住院费用显着增加（$12,732vs.18,826美元，p<0.001）。
结论：我们发现1年血栓栓塞的发生率更高，感染,急性肾功能衰竭,关节固定术组的再入院。AKA患者败血症和脑血管意外较多。以患者为中心的对话最适合持续感染和TKA翻修失败。考虑到病人的生活质量,目标,和健康状况，这个讨论应该包括每个程序的风险和并发症。
