Outcomes of Regional Block in Revision Total Joint Arthroplasty for Prosthetic Joint Infection.

Introduction: Infection is among the most common reasons for revision after a total joint arthroplasty (TJA) and is associated with notable morbidity and mortality rates. As the demand for TJA increases, a concurrent increase in the prevalence of periprosthetic joint infection (PJI) is also expected to rise. While previous studies have explored differences in postoperative outcomes between general and spinal anesthesia, there is limited data on the use of regional blocks in patients undergoing revision joint arthroplasty for PJI. This study evaluated the postoperative outcomes of patients undergoing revision TJA for PJI using regional blocks.
Methods: Data from 518 patients were retrospectively collected. Patients included in the study had undergone revision TJA for PJI from January 2004 to January 2023 at a single institution. Patients undergoing same-day bilateral revisions, above-knee amputations, and aseptic revisions were excluded. Postoperative complications investigated included local complications, postoperative transfusion, wound complication, readmission, sepsis, systemic infection, spinal infection, death, persistent PJI, periprosthetic fracture, and unplanned revision surgery. Chi-square analysis was used to compare postoperative complications between procedures that used spinal or general anesthesia with regional blocks and those with spinal or general anesthesia without regional blocks.
Results: Of the 518 patients who underwent revision TJA, 63 (12.2%) used a regional block. After surgery, 12.7% (n = 8) of patients with regional block and 23.5% (n = 107) of patients without regional block experienced persistent PJI (P = 0.076). No significant differences in wound complication (P = 0.333), readmission (P = 0.998), revision surgery (P = 0.783), and death (P = 0.588) were found between those with and without regional block use. Sepsis (P = 0.224), systemic infection (P = 0.220), and spinal infection (P = 0.998) rates within 1 year after revision TJA for PJI surgery were comparable between the two groups. No local infections were observed at the block site. A subanalysis comparing spinal and general anesthesia demonstrated comparable persistent PJI postoperatively and complication rates; however, spinal anesthesia use was associated with shorter length of stay (P = 0.003) and lower transfusion rates (P = 0.002).
Conclusion: The results of this study suggest that the use of regional block is not associated with an increased probability of postoperative persistent PJI, local wound complication, readmission, spinal/systemic/other infections, death, or revision surgery. Surgeons can comfortably choose regional block as a safe option for revision surgery for PJI. Consistent with previous research, patients who received spinal anesthesia had shorter hospital stays and lower transfusion rates when compared with those who received general anesthesia.
(Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Orthopaedic Surgeons.)