Poorer patient-reported outcome and increased risk of revision at a 5-year follow-up among patients with septic arthritis following anterior cruciate ligament reconstruction: a register-based cohort study of 23,075 primary anterior cruciate ligament reconstructions

Jesper Kraus Schmitz; Osama Omar; Adam Nordkvist; Henrik Hedevik; Per-Mats Janarv; Anders Stålman

doi:10.1007/s00167-023-07498-6

Poorer patient-reported outcome and increased risk of revision at a 5-year follow-up among patients with septic arthritis following anterior cruciate ligament reconstruction: a register-based cohort study of 23,075 primary anterior cruciate ligament reconstructions

Knee Surg Sports Traumatol Arthrosc. 2023 Oct;31(10):4090-4098. doi: 10.1007/s00167-023-07498-6. Epub 2023 Jul 3.

Authors

Jesper Kraus Schmitz¹, Osama Omar², Adam Nordkvist¹, Henrik Hedevik³, Per-Mats Janarv¹, Anders Stålman¹

Affiliations

¹ Stockholm Sports Trauma Research Center, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
² Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Vo Ortopedi, Södersjukhuset, Sjukhusbacken 10, 11883, Stockholm, Sweden. osama.omar@ki.se.
³ Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.

Abstract

Purpose: The primary aim of this study is to analyse the patient-reported outcomes after ACLR complicated by septic arthritis. The secondary aim is to examine the 5-year risk of revision surgery after primary ACLR complicated by septic arthritis. The hypothesis was that patients with septic arthritis after ACLR are more likely to have lower PROMs scores and an increased risk of revision, compared with patients without septic arthritis.

Materials and methods: All primary ACLRs, with a hamstring or patellar tendon autograft (n = 23,075), in the Swedish Knee Ligament Register (SKLR) between 2006 and 2013 were linked with data from the Swedish National Board of Health and Welfare to identify patients with postoperative septic arthritis. These patients were verified in a nationwide medical records analysis and compared with patients without infection in the SKLR. The patient-reported outcome was measured using the Knee injury and Osteoarthritis Index Score (KOOS) and the European Quality of Life Five Dimensions Index (EQ-5D) at 1, 2 and 5 years postoperatively and the 5-year risk of revision surgery was calculated.

Results: There were 268 events of septic arthritis (1.2%). The mean scores on the KOOS and EQ-5D index were significantly lower for patients with septic arthritis on all subscales on all follow-up occasions compared with patients without septic arthritis. Patients with septic arthritis had a revision rate of 8.2% compared with 4.2% in patients without septic arthritis (adjusted hazard ratio 2.04; confidence interval 1.34-3.12).

Conclusion: Patients suffering from septic arthritis following ACLR are associated with poorer patient-reported outcomes at 1-, 2- and 5-year follow-ups compared with patients without septic arthritis. The risk of revision ACL reconstruction within 5 years of the primary operation for patients with septic arthritis following ACLR is almost twice as high, compared with patients without septic arthritis.

Level of evidence: III.

Keywords: ACL; Osteoarthritis; PROMs; Revision.

MeSH terms

Anterior Cruciate Ligament Injuries* / complications
Anterior Cruciate Ligament Injuries* / surgery
Anterior Cruciate Ligament Reconstruction* / adverse effects
Anterior Cruciate Ligament Reconstruction* / methods
Arthritis, Infectious* / etiology
Arthritis, Infectious* / surgery
Cohort Studies
Follow-Up Studies
Humans
Patient Reported Outcome Measures
Quality of Life
Reoperation