Total knee arthroplasty in patients with a history of illicit intravenous drug abuse

Purpose Injection drug users are at high risk for both infection with blood-borne pathogens, namely, human immune deficiency virus (HIV), hepatitis-B, -C virus, various bacterial infections, as well as early primary and secondary joint degeneration. When total knee arthroplasty (TKA) is anticipated the risk of septic complications is a major concern. The purpose of this study was to assess the clinical and radiographic outcome of patients with a history of intravenous drug use after total knee arthroplasty. The primary outcome was revision rate. Secondary outcomes were the Western Ontario and McMaster Universities Arthritis Index (WOMAC), Knee Society Score (KSS) and radiographic loosening. Methods We retrospectively reviewed the records of 1,692 TKA performed or revised in our institution. Data of 18 TKA in 12 patients (11 male, 1 female; average age 42, range 23–62 years) with a history of intravenous opioid abuse were available for final analysis. Results The mean follow up was 125 (range 25–238) months. Seven patients required revision surgery due to periprosthetic joint infection after 62 months (range 5–159): one two staged revision, three arthrodesis and three amputations. The median prosthesis survival was 101 (95%-CI 48–154) months. Conclusion Total knee arthroplasty in patients with a history of intravenous drug abuse is associated with major complications, including above-the-knee amputation. If permanent abstinence from intravenous drug abuse is doubtful, other therapeutic options including primary arthrodesis should be considered.