A History of Treated Periprosthetic Joint Infection Increases the Risk of Subsequent Different Site Infection

Abstract

Background After the successful treatment of periprosthetic joint infection (PJI), patients may present with degenerative joint disease in another joint with symptoms severe enough to warrant arthroplasty. However, it is not known whether patients with a history of treated PJI at one site will have an increased risk of PJI in the second arthroplasty site.Questions/purposes The primary objective of this study is to determine if there is a difference in the risk of developing a PJI after a second total hip arthroplasty (THA) or total knee arthroplasty (TKA) in patients who have had a previous PJI at another anatomic site compared with patients who have had no history of PJI. The secondary objective is to determine other potential risk factors that may predict PJI at the site of the second arthroplasty. Methods A retrospective matched cohort study was performed to identify all patients at four academic institutions successfully treated for PJI who subsequently underwent a second primary THA or TKA (n = 90), constituting our study group. Patients were matched (one-to-one) to control subjects who had no history of PJI after their first arthroplasty (n = 90); they were matched based on age, sex, diabetic status, BMI, American Society of Anesthesiologists, institution, joint of interest, and year of surgery (± 2 years). We compared the case and control groups to determine whether a prior infection increased the relative risk of a subsequent PJI at another anatomic site. To identify other potential risk factors for subsequent PJI, a subgroup univariate analysis of our study group (n = 90) Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

Osteomyelitis: Recent advances in pathophysiology and therapeutic strategies

“…25,28 Patients with a history of PJI had a greater risk of developing PJI in a subsequent THA or TKA. 29 In 2011, the Musculoskeletal Infection Society proposed a unique set of PJI criteria, which were later revised at the International Consensus Meeting (ICM) on PJI. The diagnosis of PJI can be established if one of the following three major criteria occurs: two positive periprosthetic cultures with identical organisms; a sinus tract communicating with the joint; having three of the following minor criteria: (a) elevated serum C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), (b) elevated synovial fluid white blood cell (WBC) count, (c) elevated synovial fluid polymorphonuclear neutrophil percentage, (d) positive histological analysis of periprosthetic tissue, and (e) a single positive culture of periprosthetic tissue or fluid.…”

Multi‐disciplinary antimicrobial strategies for improving orthopaedic implants to prevent prosthetic joint infections in hip and knee

“…Due to the likelihood of undiagnosed PJIs, the exact number of PJI‐related revisions is unclear. Importantly, however, known PJI‐related revisions are more costly and time consuming than others, and increase the probability of poor prognosis (e.g., limb salvage operations or PJI recurrence) . Therefore, recognizing the unique biological characteristics of relevant microbial organisms and their infection‐causing mechanisms are of utmost importance for both preventing and treating PJIs.…”

Silver Nanocoating Technology in the Prevention of Prosthetic Joint Infection

“…Generally, PJI leads to implant removal and long-term antibiotic therapy with a permanent, increased risk for PJI development in affected patients [3]. …”