Inadequate evaluation and management of suspected-infections after TKA surgery in Lithuania: a retrospective study of 2 769 patients with 2-year follow-up up

Abstract

Introduction The evidence-based algorithms for treatment of periprosthetic joint infection (PJI) recommends surgical intervention in combination with use of systemic antibiotics. However, still it is not unusual to treat total knee arthroplasty (TKA) patients with suspected infection only using antibiotics. Aims and Objectives We evaluated how suspected infection after TKA was treated in “real life” in Lithuania, with respect adherence to guidelines and investigated the outcome of antibiotic treatment without surgical intervention. Materials and methods Of the 4 069 TKA patients (4 269 knees) registered in the Lithuanian Arthroplasty Register (2013–2015) 2 769 patients (2 825 knees), were interviewed 2 years after the surgery. The patients were inquired if they had been subject to antibiotics treatment after the TKA surgery and/or if any additional surgical interventions on the operated knee had been performed. The number of patients treated with antibiotics due to problems in the operated knee was identified and cumulative revision rates (CRR) were calculated. Results 180 (7 %) patients out of the 2 769 reported that they had been prescribed antibiotics after the primary TKA, 132 of these patients (70 %) said they had received antibiotics due to problems with the operated knee. The 2-year CRR after TKA in patients not treated with antibiotics was 0.7 % (95 % CI 0.4-1), as compared to 24 % (95 % CI 17–32) in those who had used antibiotics due to the problems in operated knee for more than 1 week. Conclusions In Lithuania there seems to be a lack of adherence to evidence based treatment guidelines when infection is suspected after primary TKA.