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. See the Guidelines for Authors for a complete description of levels of evidence.

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Available from: Javad Parvizi, Jan 25, 2014
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    • "Reports have shown that the general condition of the patient's health has a direct link with the rate of postoperative complications; and conditions such as ASA > 2, uncontrolled diabetes, and rheumatoid arthritis can significantly increase the risk of PJI.[4,22,262728Therefore, it is mandatory to assess all patients in a multidisciplinary approach prior to TJA and to manage comorbidities if required. These assessments have shown to reduce the postoperative mortality rate and per-admission costs significantly in complex orthopaedic surgeries, including TJA.[30]Marchant et al. found that patients with a higher level of hemoglobin A1c had significantly higher incidence of PJI, at an odds ratio of 2.31.[31]Furthermore, "
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    ABSTRACT: Prosthetic joint infection (PJI) is a serious complication with high morbidity, mortality, and substantial cost. The reported incidence is probably underestimated due to the problems of proper diagnosis. PJI has haunted the orthopedic community for several years and despite all the advances in this field, it is still a demanding issue with a huge impact on patients, surgeons, and healthcare. Numerous elements can predispose patients to PJI. In this chapter, we tried to summarize the effective prevention strategies along with the recommendations of a recent International Consensus Meeting on Surgical Site and Periprosthetic Joint Infection.
    Full-text · Chapter · Jan 2016
    • "Prosthetic joint infection (PJI) remains a dangerous and at times lethal complication that significantly decreases quality of life of patients after total hip arthroplasty (THA). According to various studies, incidence of PJI is within the range of 0.3– 2.22 % after primary THA to 5.9 % after revision surgery123456. The optimal approach to manage PJI requires complete eradication of infection which is usually achieved with revision surgery and long-term antibiotic therapy. "
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    ABSTRACT: Purpose The purpose of this study was evaluation of the efficacy of the first step of a two-stage procedure for treatment of hip prosthetic joint infection (PJI) using articulating and non-articulating spacers as well as development of a prediction model and prognostic score for infection recurrence. Methods In a cohort of 217 patients treated for PJI of the hip, demographic characteristics, clinical symptoms, body temperature, body mass index (BMI), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), white blood cell count (WBC), microbiological cultures and the type of the spacer used were retrospectively analyzed for association with the recurrence of PJI. Results Patients with infection recurrence had increased levels of ESR and CRP (P < 0.001) together with higher BMI and shorter infection manifestation period after previous surgery (P < 0.05). Among these patients, there was no significant difference of clinical characteristics between subjects with articulating and non-articulating spacers. Microbial associations were more often identified in patients with recurrent infection (50 %, P < 0.01) where Gram-negative bacteria were predominant (61.5 %, P < 0.01). These patients had higher percentage of Acinetobacter sp. and P. aeruginosa isolates (28.2 %, P < 0.01). Conclusions Efficacy of the first step of two-stage revision was 64.1 %. Placement of either articulating or non-articulating spacers did not influence recovery from PJI. Laboratory values of ESR, CRP, BMI and the type of previous surgery were identified as main factors that affect outcomes of the two-stage procedure. A prognostic model with the calculation of a total risk score for PJI recurrence was developed.
    No preview · Article · Dec 2015 · International Orthopaedics
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    • "Despite this there are no studies looking at the effect of INPWT on this group. Saleh et al. and Pulido et al. extensively described risk factors associated with higher rates of periprosthetic infection such as malnutrition, excess anticoagulation, obesity, diabetes, and a high American Society of Anesthesiologists (ASA) score [7] [8]. However Patel et al. and Weiss and Krackow identified persistent wound drainage lasting greater than 48 hours after hip arthroplasty as also a risk factor for periprosthetic joint infection [9] [10]. "
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    ABSTRACT: Incisional negative pressure wound therapy (INPWT) has been used for high-risk surgery across specialties but has yet to be utilised for revision hip and knee surgery. Between 2013 and 2014, patients who underwent revision arthroplasty by the senior author were identified. 36 (9 hips and 27 knees) operations in 36 patients identified 18 (8 male, median age 77 (61–86)) who received standard dressing and 18 (12 male, median age 67 (58–81)) who received single use portable INPWT dressings (4 hips, 14 knees). Wound complications were seen in 3 (2 knees) from the standard group and 1 (hip) in the INPWT group ( p = 0.14 ). There was no statistical difference in age or gender between groups. Risk factors (BMI > 30, smoking, and diabetes) were identified in 9 patients, median ASA 3, in the standard group and 10 patients, median ASA 2, in the INPWT group. There were no dressing related complications. This is the first study of INPWT with a low pressure single use 80 mmHg dressing with revision arthroplasty. This initial study showed a threefold decrease in wound complication in the INPWT group and that INPWT is a safe alternative to standard dressings.
    Full-text · Article · Nov 2015
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