Risk factors for revision due to prosthetic joint infection following total knee arthroplasty based on 62,087 knees in the Finnish Arthroplasty Register from 2014 to 2020


  • Hannes Keemu Department of Orthopaedics and Traumatology, Turku University Hospital and University of Turku, Turku
  • Kasperi J Alakylä Department of Orthopaedics and Traumatology, Turku University Hospital and University of Turku, Turku
  • Riku Klén Turku PET Centre, University of Turku and Turku University Hospital, Turku https://orcid.org/0000-0002-0982-8360
  • Valtteri J Panula Department of Orthopaedics and Traumatology, Turku University Hospital and University of Turku, Turku https://orcid.org/0000-0001-6638-3188
  • Mikko S Venäläinen Turku Bioscience Centre, University of Turku and Åbo Akademi University, Turku; Department of Medical Physics, Turku University Hospital, Turku https://orcid.org/0000-0003-1777-4259
  • Jaason J Haapakoski National Institute for Health and Welfare, Helsinki https://orcid.org/0000-0001-5145-3956
  • Antti P Eskelinen Coxa Hospital for Joint Replacement and Faculty of Medicine and Health Technologies, University of Tampere, Tampere https://orcid.org/0000-0003-0302-0253
  • Konsta Pamilo Coxa Hospital for Joint Replacement and Faculty of Medicine and Health Technologies, University of Tampere, Tampere https://orcid.org/0000-0001-5961-4072
  • Jukka S Kettunen Department of Orthopaedics and Traumatology, Kuopio University Hospital, Kuopio https://orcid.org/0000-0002-2797-2497
  • Ari-Pekka Puhto OYS Centre for Musculoskeletal Surgery, Oulu University Hospital, Oulu https://orcid.org/0000-0002-5006-4876
  • Anna I Vasara Department of Orthopaedics and Traumatology, Helsinki University Hospital and University of Helsinki, Finland https://orcid.org/0000-0001-6706-1674
  • Laura L Elo Turku Bioscience Centre, University of Turku and Åbo Akademi University, Turku
  • Keijo T Mäkelä Department of Orthopaedics and Traumatology, Turku University Hospital and University of Turku, Turku




Arthroplasty, Infection, Knee


Background and purpose: Periprosthetic joint infection (PJI) is the commonest reason for revision after total knee arthroplasty (TKA). We assessed the risk factors for revision due to PJI following TKA based on the Finnish Arthroplasty Register (FAR).
Patients and methods: We analyzed 62,087 primary condylar TKAs registered between June 2014 and February 2020 with revision for PJI as the endpoint. Cox proportional hazards regression was used to estimate hazard ratios (HR) with 95% confidence intervals (CI) for the first PJI revision using 25 potential patient- and surgical-related risk factors as covariates.
Results: 484 knees were revised for the first time during the first postoperative year because of PJI. The HRs for revision due to PJI in unadjusted analysis were 0.5 (0.4–0.6) for female sex, 0.7 (0.6–1.0) for BMI 25–29, and 1.6 (1.1–2.5) for BMI > 40 compared with BMI < 25, 4.0 (1.3–12) for preoperative fracture diagnosis compared with osteoarthritis, and 0.7 (0.5–0.9) for use of an antimicrobial incise drape. In adjusted analysis the HRs were 2.2 (1.4–3.5) for ASA class III–IV compared with class I, 1.7 (1.4–2.1) for intraoperative bleeding ≥ 100 mL, 1.4 (1.2–1.8) for use of a drain, 0.7 (0.5–1.0) for short duration of operation of 45–59 minutes, and 1.7 (1.3–2.3) for long operation duration > 120 min compared with 60–89 minutes, and 1.3 (1.0–1.8) for use of general anesthesia.
Conclusion: We found increased risk for revision due to PJI when no incise drape was used. The use of drainage also increased the risk. Specializing in performing TKA reduces operative time and thereby also the PJI rate.


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FAR: Finnish arthroplasty register. Finnish Inst. Heal. Welf. [Internet]. 2022. Available from: www.thl.fi/FAR.

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How to Cite

Keemu, H., Alakylä, K. J., Klén, R., Panula, V. J., Venäläinen, M. S., Haapakoski, J. J., Eskelinen, A. P., Pamilo, K., Kettunen, J. S., Puhto, A.-P., Vasara, A. I., Elo, L. L., & Mäkelä, K. T. (2023). Risk factors for revision due to prosthetic joint infection following total knee arthroplasty based on 62,087 knees in the Finnish Arthroplasty Register from 2014 to 2020. Acta Orthopaedica, 94, 215–223. https://doi.org/10.2340/17453674.2023.12307

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