Article
Mid-term survival of geriatric patients with septic arthritis of the knee and risk factors affecting survival
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Authors
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Markus Geßlein
- Orthopädie und Unfallchirurgie, Klinikum Nürnberg, Nürnberg, Germany; Paracelsus Medizinische Privatuniversität, Nürnberg, Germany
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Nina Haag
- Radiologie, Neuroradiologie und Nuklearmedizin, Mühlenkreiskliniken Minden, Minden, Germany; Paracelsus Medizinische Privatuniversität, Nünberg, Germany
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Johannes Rüther
- Klinik für Orthopädie und Unfallchirurgie, Klinikum Nürnberg, Nürnberg, Germany; Paracelsus Medizinische Privatuniversität, Nürnberg, Germany
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Jörg Steinmann
- Institut für Klinikhygiene und Mikrobiologie, Klinikum Nürnberg, Nürnberg, Germany; Paracelsus Medizinische Privatuniversität, Nürnberg, Germany
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Maximilian Willauschus
- Klinik für Orthopädie und Unfallchirurgie, Klinikum Nürnberg, Nürnberg, Germany; Paracelsus Medizinische Privatuniversität, Nürnberg, Germany
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Renate Ziegler
- Institut für Klinikhygiene und Mikrobiologie, Klinikum Nürnberg, Nürnberg, Germany; Paracelsus Medizinische Privatuniversität, Nürnberg, Germany
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Hermann Josef Bail
- Klinik für Orthopädie und Unfallchirurgie, Klinikum Nürnberg, Nürnberg, Germany; Paracelsus Medizinische Privatuniversität, Nürnberg, Germany
| Published: | October 25, 2022 |
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Outline
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Objectives: Septic arthritis is common in older adults and related to joint surgery or hematogenous distribution. However, risk factors affecting survival are missing especially in an older population which is likely to suffer most from impaired mobility. This study aims to evaluate the effect of existing medical implants, positive synovial microbiological culture results, and the American Society of Anesthesiology Physical Status (ASA) Classification on mid-term survival of older patients with primary septic gonarthritis.
Methods: Patients were identified via clinical records of a maximum medical care hospital from January 1st, 2007, to October 31st, 2020. From a total number of 238 patients admitted to the emergency department for septic arthritis, 179 patients were included and a complete follow up could be fulfilled from 133 patients (74.3%).
Inclusion criteria were age above 60 years, primary septic monoarthritis of the knee joint, and meeting at least one of the Newman criteria for septic arthritis.
Exclusion criteria were periprosthetic joint infection, the incompleteness of medical records, unavailability of survival data, recent (<6 months) surgery, open skin defects at the knee, or general wound treatment, and the diagnosis of acute gout, rheumatoid arthritis, or crystal arthropathies. Data was collected from medical records and public obituaries. Kaplan-Meyer-Survival-Curves were used to estimate the probability of survival, and the Log rank-test to compare survival rates over a five-year period.
Results and conclusion: The mean age was 74.9 years (SD ± 9.2), 5-year follow-up-rate was 74.3%, mean follow-up was 3000.5 days (SD ± 1771.6). Mean survival was significantly different in patients with implants and without implants (p=0.015), and with ASA II, ASA III, and ASA IV (p<0.001.) There was no significant difference in survival of patients with or without a positive synovial microbiological culture (p=0.08). Older adults with septic monoarthritis and preexisting medical implants show impaired survival. ASA classification prior to surgery for primary septic monoarthritis can be helpful to identify patients with poorer mid-term outcome.
