Pioneering in the first century of hip replacement: experiences of a surgeon-designer

A retrieval analysis perspective on revision for infection

Background

Retrieval analysis has long served the orthopaedic community as a tool for understanding implant failure modes; however, what retrieval studies can reveal about the nature of prosthetic joint infection (PJI) remains unknown. We hypothesize that records from a comprehensive joint retrieval program should corroborate clinically-reported temporal characteristics of prosthesis-related infection.

Methods

We examined 2527 records documenting a decade of explanted hip and knee components to quantify the following: (1) the relative contribution of infection to revision arthroplasty; (2) the effects of joint type, revision status, and reason for retrieval on indwelling time; and (3) whether the temporal distribution of infected explants reflects clinical experience.

Results

In this series, 20% (507/2527) of explants were performed for infection, with PJI being more commonly implicated in the retrieval of revision implants than of primaries. Infected prostheses were explanted 23.2 months sooner on average than those retrieved for other causes. Within the subset of infected devices, revision components were explanted 11.2 months sooner than primaries, with no appreciable difference observed between hips and knees. Retrieval-based temporal distributions were most similar to PJI studies with endpoint enrollment or long duration follow-up, suggesting a later average onset of infection than reported in comparable clinical studies with short (<10-year) follow-up.

Conclusions

Infection represents a major cause of revision arthroplasty, and is associated with shorter indwelling times in revision components than in primaries. Studies with less than 10 years of follow-up are likely to under-report late PJI.

Self-inflicted risks of orthopaedic surgery

The advancements in medicine, including orthopaedic treatment, since 1960 have so greatly improved quality of life that human nature has changed in its social goals. These technological innovations, especially the products created, have resulted in a self-inflicted increase in risk of practice. This risk will not be leveled until society recognizes that it expects that the physician not only be a healer, but able to fulfill the social goals of the patient.