Periprosthetic Joint Infection: The Incidence, Timing, and Predisposing Factors

Rothman Institute of Orthopedics, Thomas Jefferson University Hospital, 925 Chestnut Street, Philadelphia, PA 19107, USA.
Clinical Orthopaedics and Related Research (Impact Factor: 2.77). 08/2008; 466(7):1710-5. DOI: 10.1007/s11999-008-0209-4
Source: PubMed


Periprosthetic joint infection is one of the most challenging complications of joint arthroplasty. We identified current risk factors of periprosthetic joint infection after modern joint arthroplasty, and determined the incidence and timing of periprosthetic joint infection. We reviewed prospectively collected data from our database on 9245 patients undergoing primary hip or knee arthroplasty between January 2001 and April 2006. Periprosthetic joint infections developed in 63 patients (0.7%). Sixty-five percent of periprosthetic joint infections developed within the first year of the index arthroplasty. The infecting organism was isolated in 57 of 63 cases (91%). The most common organisms identified were Staphylococcus aureus and Staphylococcus epidermidis. We identified the following independent predictors for periprosthetic joint infection: higher American Society of Anesthesiologists score, morbid obesity, bilateral arthroplasty, knee arthroplasty, allogenic transfusion, postoperative atrial fibrillation, myocardial infarction, urinary tract infection, and longer hospitalization. This study confirmed some previously implicated factors and identified new variables that predispose patients to periprosthetic joint infection. LEVEL OF EVIDENCE: Level II, prognostic study.

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Available from: Javad Parvizi, Jan 25, 2014
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    • "In addition, it is possible that patients have catheters introduced perioperatively for hygiene issues, fluid monitoring, or unexpected neurogenic bladder as a side effect of the spinal anaesthetic and immobilization. Catheter usage has been shown to increase the rate of urinary tract infection and could potentially lead to subsequent joint infection [29] [30] [31]. A recent study recommended total hip replacement surgery under spinal anaesthesia be performed without the use of a catheter to decrease the rate of postoperative infections [32]. "
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    ABSTRACT: Spinal anaesthesia when compared to general anaesthesia has been shown to decrease postoperative morbidity in orthopaedic surgery. The aim of the present study was to assess the differences in thirty-day morbidity and mortality for patients undergoing hip fracture surgery with spinal versus general anaesthesia. The American College of Surgeons National Surgical Quality and Improvement Program (NSQIP) database was used to identify patients who underwent hip fracture surgery with general or spinal anaesthesia between 2010 and 2012 using CPT codes 27245 and 27244. Patient characteristics, complications, and mortality rates were compared. Univariate analysis and multivariate logistic regression were used to identify predictors of thirty-day complications. Stratified propensity scores were employed to adjust for potential selection bias between cohorts. 6133 patients underwent hip fracture surgery with spinal or general anaesthesia; 4318 (72.6%) patients underwent fracture repair with general anaesthesia and 1815 (27.4%) underwent fracture repair with spinal anaesthesia. The spinal anaesthesia group had a lower unadjusted frequency of blood transfusions (39.34% versus 45.49%; p<0.0001), deep vein thrombosis (0.72% versus 1.64%; p=0.004), urinary tract infection (8.87% versus 5.76%; p<0.0001), and overall complications (45.75% versus 48.97%; p=0.001). The length of surgery was shorter in the spinal anaesthesia group (55.81 versus 65.36min; p<0.0001). After multivariate logistic regression was used to adjust for confounders, general anaesthesia (odds ratio, 1.29; 95% confidence interval, 1.14-1.47; p=0.0002) was significantly associated with increased risk for complication after hip fracture surgery. Age, female sex, body mass index, hypertension, transfusion, emergency procedure, operation time, and ASA score were risk factors for complications after hip fracture repair (all p<0.05). Patients who underwent hip fracture surgery with general anaesthesia had a higher risk of thirty-day complications as compared to patients who underwent hip fracture repair with spinal anaesthesia. Surgeons should consider using spinal anaesthesia for hip fracture surgery. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Injury 02/2015; 17(4). DOI:10.1016/j.injury.2015.02.002 · 2.14 Impact Factor
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    • "Meticulous evaluation of the patient's medical and surgical history as well as comprehensive physical examination is an important screening tool for PJI and helps to guide the subsequent diagnostic evaluation. Identification of the patient's comorbidities could raise the possibility of PJI as the cause of pain or failure, so precise history taking concerning specific risk factors (diabetes mellitus, use of corticosteroids , obesity, rheumatoid arthritis and other inflammatory arthritis, chronic renal failure, malnutrition, and immunocompromised state) is very important [9]. Previous wound healing problems, prolonged perioperative antibiotic administration, rapid unexplained prosthetic failure, or repeated surgery are historical clues often associated with PJI [18e21]. "
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    ABSTRACT: Although total hip arthroplasty (THA) is accepted as one of the most successful surgical procedures in orthopaedic surgery, periprosthetic joint infection after THA continues to be one of the most devastating complications. However, accurate preoperative identification of periprosthetic joint infection in patients presenting with joint pain or radiographic periprosthetic lucencies is often difficult, even after a comprehensive work-up. The purpose of this article is to review the diagnostic options available to improve the management and results of this potentially catastrophic complication.
    11/2014; 3(1). DOI:10.1016/
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    • "Although very successful procedure, complications do occur. One of the most feared complication is periprosthetic infection which develops in 0.4–2% of patients [5]. Periprosthetic infection is source of repeated procedures, prolonged hospitalization, poor final functional status, increased morbidity, poor quality of life and increased cost of treatment [6] [7] [8]. "
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    ABSTRACT: Periprosthetic infection is regarded as one of the most feared complications following total knee arthroplasty, developing in 0.4-2% of patients. Staphylococcus aureus and Staphylococcus epidermidis are credited for more than half of all infections. Cefazolin is the most commonly used antibiotic drug in arthroplasty antibiotic prophylaxis worldwide. Guidelines and studies recommend that prophylactic antibiotics should be completely infused within 60min before the surgical incision. Cefazolin achieves highest peak bone concentrations 40min after parenteral application with serum half-life of 108min and bone half-life of 42min. Respecting the given pharmacokinetics of cefazolin and theoretical mathematical model we hypothesise that parenteral application of cefazolin should be in time period not longer than 30min before incision (tourniquet inflation) and not less than 10min before tourniquet inflation if given in bolus. This new regime would provide maximal blood concentration of the cefazolin and almost maximal bone concentration of the cefazolin at the beginning of the operation and at the beginning of the tourniquet inflation.
    Medical Hypotheses 03/2014; 82(6). DOI:10.1016/j.mehy.2014.03.020 · 1.07 Impact Factor
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