Younger age is associated with a higher risk of early periprosthetic joint infection and aseptic mechanical failure after total knee arthroplasty.
BACKGROUND
Although early aseptic mechanical failure after total knee arthroplasty has been reported in younger patients, it is unknown whether early revision due to periprosthetic joint infection is more or less frequent in this patient subgroup. The purpose of this study was to determine whether the incidence of early periprosthetic joint infection requiring revision knee surgery is significantly different in patients younger than fifty years of age compared with older patients following primary unilateral total knee arthroplasty.


METHODS
A large population-based study was conducted with use of the California Patient Discharge Database, which allows serial linkage of all discharge data from nonfederal hospitals in the state over time. Patients undergoing primary unilateral total knee arthroplasty during 2005 to 2009 were identified. Principal outcomes were partial or complete revision arthroplasty due to periprosthetic joint infection or due to aseptic mechanical failure within one year. Multivariate analysis included risk adjustment for important demographic and clinical variables. The effect of hospital total knee arthroplasty volume on the outcomes of infection and mechanical failure was analyzed with use of hierarchical modeling.


RESULTS
At one year, 983 (0.82%) of 120,538 primary total knee arthroplasties had undergone revision due to periprosthetic joint infection and 1385 (1.15%) had undergone revision due to aseptic mechanical failure. The cumulative incidence in patients younger than fifty years of age was 1.36% for revision due to periprosthetic joint infection and 3.49% for revision due to aseptic mechanical failure. In risk-adjusted models, the risk of periprosthetic joint infection was 1.8 times higher in patients younger than fifty years of age (odds ratio = 1.81, 95% confidence interval = 1.33 to 2.47) compared with patients sixty-five years of age or older, and the risk of aseptic mechanical failure was 4.7 times higher (odds ratio = 4.66, 95% confidence interval = 3.77 to 5.76). The rate of revision due to infection at hospitals in which a mean of more than 200 total knee arthroplasties were performed per year was lower than the expected (mean) value (p = 0.04).


CONCLUSIONS
Patients younger than fifty years of age had a significantly higher risk of undergoing revision due to periprosthetic joint infection or to aseptic mechanical failure at one year after primary total knee arthroplasty.
Department of Orthopaedic Surgery, University of California Davis, 4860 Y Street, Suite 3800, Sacramento, CA 95817. E-mail address: John.Meehan@ucdmc.ucdavis.edu.
John P
JP
Meehan
Health Information Solutions, 2425 Clubhouse Drive, Rocklin, CA 95765.
Beate
B
Danielsen
School of Medicine, University of California Davis, 2921 Stockton Boulevard, Suite 1400, Sacramento, CA 95817.
Sunny H
SH
Kim
Joint Preservation Institute, 2825 J Street, Suite 440, Sacramento, CA 95816.
Amir A
AA
Jamali
Department of Medicine, University of California Davis, Suite 2400, PSSB, 4150 V Street, Sacramento, CA 95817.
Richard H
RH
White
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee; D002140:California; D005260:Female; D006801:Humans; D015994:Incidence; D007720:Knee Prosthesis / Q000009:adverse effects*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011475:Prosthesis Failure / Q000209:etiology*; D016459:Prosthesis-Related Infections / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome