Anemia before reimplantation surgery - An overlooked modifiable risk factor of septic revision knee arthroplasty failure.
anemia
patient blood management
perioperative medicine
revision arthroplasty
surgical site infection
Journal
SICOT-J
ISSN: 2426-8887
Titre abrégé: SICOT J
Pays: France
ID NLM: 101675099
Informations de publication
Date de publication:
2020
2020
Historique:
received:
12
11
2020
accepted:
14
11
2020
entrez:
11
12
2020
pubmed:
12
12
2020
medline:
12
12
2020
Statut:
ppublish
Résumé
Preoperative anemia in patients undergoing a two-stage septic revision arthroplasty may be a factor of reinfection, even in the presence of aggressive antimicrobial therapy. Patient Blood Management (PBM) in such patients is challenging. We evaluate the impact of anemia existing before re-implantation on a failure rate after two-stage septic total knee arthroplasty (rTKA), and explore feasibility of a PBM strategy implementation in these patients. A retrospective study of patients from January 2010 to January 2015 in a French regional referral center was performed. Patients undergoing a two-stage rTKA for infection after successful primary TKA were identified and followed up to 31.12.2018. The primary outcome (failure) was defined as surgical site infection after re-implantation requiring new surgery. The secondary outcomes were time to failure, the time between explantation/reimplantation, transfusion rate during the second stage. Preoperative anemia was defined as Hb level < 12 g/L before the re-implantation. 69 patients were identified; 17 (24%) developed reinfection of rTKA in 105 [11.4-156] days. In these patients pre-implantation anemia was more frequent (n = 13(76.5%) in failed vs. n = 21(40%) in non-failed, p = 0.0110). During the explantation stage, there were no significant group differences in age, sex, comorbidity, type of spacer and antimicrobial therapy, iron supplementation, or transfusion rate. The median time between explantation/reimplantation surgery was 51 [43-71.5] days, indifferent between the two groups. Intraoperative transfusion during reimplantation was required in 12 (17%) patients, more frequent in failed patients. None of the patients had contraindications for the PBM strategy except the cell-saver use. In two-stage septic rTKA preoperative anemia was almost two times more frequent and associated with an elevated rate of septic failure. The time-frame between explantation and-re-implantation is sufficient to implement a PBM strategy for all anemic patients. Before-after studies would be of interest to determine the best PBM strategy to prevent anemia-associated septic failure in such a condition.
Identifiants
pubmed: 33306020
doi: 10.1051/sicotj/2020046
pii: sicotj200134
pmc: PMC7731908
doi:
Types de publication
Journal Article
Langues
eng
Pagination
47Informations de copyright
© The Authors, published by EDP Sciences, 2020.
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