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Peer-reviewedCC BYBMC musculoskeletal disorders

Risk factors for surgical site infection requiring reoperation after osteotomy around the knee: a multicenter retrospective study.

  • Yuji Arai1
  • Shuji Nakagawa2
  • Yusei Katsuyama3
  • Atsuo Inoue3
  • Koichi Idei4
  • Shohei Ichimaru5
  • Keisuke Sugie3
  • Kentaro Hayashi3
  • Kenji Takahashi3
5 affiliations
  1. 1Department of Sports and Para-Sports Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.
  2. 2Department of Sports and Para-Sports Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan. [email protected].
  3. 3Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, 602-8566, Japan.
  4. 4Department of Orthopedics, Kanai Hospital, Kyoto, 613-0911, Japan.
  5. 5Department of Orthopedics, Koseikai Takeda Hospital, Kyoto, 600-8558, Japan.
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Abstract

Background

Osteotomy around the knee (OAK) is an established joint-preserving procedure for knee osteoarthritis; however, postoperative surgical site infection (SSI) remains a serious complication that may compromise bone healing and functional outcomes. Evidence regarding risk factors for SSI requiring reoperation after OAK is limited. This study aimed to identify perioperative factors associated with SSI requiring reoperation following OAK.Methods

This multicenter retrospective study included 247 patients (302 knees) who underwent OAK at one institution and two affiliated hospitals between June 2015 and June 2024. SSI was defined as an infection requiring surgical debridement. Patient demographics, comorbidities, perioperative laboratory data, and surgical variables were evaluated. Factors associated with SSI were identified using Firth's penalized multivariable logistic regression. Sensitivity analyses were performed after excluding knees that underwent osteotomy for valgus deformity and after restricting the dataset to one knee per patient.Results

SSI requiring reoperation occurred in 12 of 302 knees (4.0%). Firth's penalized multivariable logistic regression identified preoperative skin disease, preoperative liver disease, and postoperative hemoglobin decline as factors independently associated with SSI. These associations remained consistent in sensitivity analyses excluding knees that underwent osteotomy for valgus deformity and restricting the analysis to one knee per patient.Conclusions

Preoperative skin disease, preoperative liver disease, and postoperative hemoglobin decline were independently associated with an increased risk of SSI requiring reoperation after OAK. Awareness of these factors may aid perioperative risk assessment and postoperative surveillance. Further prospective studies with larger cohorts are needed to validate these findings and establish clinically applicable strategies for infection risk assessment and prevention.

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Cite

BibTeXRIS
BibTeX
@article{arai2026risk,
  title = {{Risk factors for surgical site infection requiring reoperation after osteotomy around the knee: a multicenter retrospective study.}},
  author = {Yuji Arai and Shuji Nakagawa and Yusei Katsuyama and Atsuo Inoue and Koichi Idei and Shohei Ichimaru and Keisuke Sugie and Kentaro Hayashi and Kenji Takahashi},
  journal = {BMC musculoskeletal disorders},
  year = {2026},
  month = jul,
  doi = {10.1186/s12891-026-10277-2},
  url = {https://europepmc.org/article/MED/42897581},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Risk factors for surgical site infection requiring reoperation after osteotomy around the knee: a multicenter retrospective study.
AU  - Yuji Arai
AU  - Shuji Nakagawa
AU  - Yusei Katsuyama
AU  - Atsuo Inoue
AU  - Koichi Idei
AU  - Shohei Ichimaru
AU  - Keisuke Sugie
AU  - Kentaro Hayashi
AU  - Kenji Takahashi
PY  - 2026
DA  - 2026/07/01
JO  - BMC musculoskeletal disorders
DO  - 10.1186/s12891-026-10277-2
UR  - https://europepmc.org/article/MED/42897581
AB  - Background  Osteotomy around the knee (OAK) is an established joint-preserving procedure for knee osteoarthritis; however, postoperative surgical site infection (SSI) remains a serious complication that may compromise bone healing and functional outcomes. Evidence regarding risk factors for SSI requiring reoperation after OAK is limited. This study aimed to identify perioperative factors associated with SSI requiring reoperation following OAK.Methods  This multicenter retrospective study included 247 patients (302 knees) who underwent OAK at one institution and two affiliated hospitals between June 2015 and June 2024. SSI was defined as an infection requiring surgical debridement. Patient demographics, comorbidities, perioperative laboratory data, and surgical variables were evaluated. Factors associated with SSI were identified using Firth's penalized multivariable logistic regression. Sensitivity analyses were performed after excluding knees that underwent osteotomy for valgus deformity and after restricting the dataset to one knee per patient.Results  SSI requiring reoperation occurred in 12 of 302 knees (4.0%). Firth's penalized multivariable logistic regression identified preoperative skin disease, preoperative liver disease, and postoperative hemoglobin decline as factors independently associated with SSI. These associations remained consistent in sensitivity analyses excluding knees that underwent osteotomy for valgus deformity and restricting the analysis to one knee per patient.Conclusions  Preoperative skin disease, preoperative liver disease, and postoperative hemoglobin decline were independently associated with an increased risk of SSI requiring reoperation after OAK. Awareness of these factors may aid perioperative risk assessment and postoperative surveillance. Further prospective studies with larger cohorts are needed to validate these findings and establish clinically applicable strategies for infection risk assessment and prevention.
SN  - 1471-2474
ER  -