Do Prosthetic Joint Infections Worsen the Functional Ambulatory Outcome of Patients with Joint Replacements? A Retrospective Matched Cohort Study

Abstract

Objectives: To assess the effect on the functional ambulatory outcome of postoperative joint infection (PJI) cured at the first treatment attempt versus not developing PJI in patients with hip and knee prostheses. Methods: In a single-hospital retrospectively matched cohort study, each patient with PJI between 2007 and 2016 was matched on age, sex, type of prosthesis and year of implantation with two other patients with uninfected arthroplasties. The definition of a PJI cure included infection eradication, no further surgical procedures, no PJI-related mortality and no suppressive antibiotics. Functional ambulatory status evaluated one year after the last surgery was classified into four simple categories: able to walk without assistance, able to walk with one crutch, able to walk with two crutches, and unable to walk. Patients with total hip arthroplasties (THAs), total knee arthroplasties (TKAs) and partial hip arthroplasties (PHAs) were analysed separately. Results: A total of 109 PJI patients (38 TKA, 41 THA, 30 PHA) and 218 non-PJI patients were included. In a model adjusted for clinically relevant variables, PJI was associated with a higher risk of needing an assistive device for ambulation (vs. walking without aid) among THA (adjusted odds ratio (OR) 3.10, 95% confidence interval (95% CI) 1.26–7.57; p = 0.014) and TKA patients (OR 5.40, 95% CI 2.12–13.67; p < 0.001), and with requiring two crutches to walk or being unable to walk (vs. walking unaided or with one crutch) among PHA patients (OR 3.05, 95% CI 1.01–9.20; p = 0.047). Conclusions: Ambulatory outcome in patients with hip and knee prostheses with postoperative PJI is worse than in patients who do not have PJI.

Mortality, patient-reported outcome measures, and the health economic burden of prosthetic joint infection

“…Six of the eight studies ( 3 , 15 , 16 , 17 , 19 , 20 ) assessed the patients’ post-surgical joint pain and function using an appropriate joint function tool (ambulatory outcomes, OHS, OKS, HHS, or WOMAC). Wildeman et al ( 3 ) and Mur et al ( 20 ) reported a greater proportion of PJI patients requiring ambulatory aids and assisted living relative to uninfected patients ( Table 2 ). Wildeman et al ( 3 ) identified a worse OHS score in PJI patients.…”

Repurposed Fenoprofen Targeting SaeR Attenuates Staphylococcus aureus Virulence in Implant-Associated Infections

“…In contrast to the treatment of other infections, the goal of orthopedic implant-associated infection treatment is not only to eradicate the infection but also to relieve pain and maintain joint function. , Orthopedic implant-associated infection impairs the patient’s walking ability, which is caused by the pain and osteolysis resulting from the infection . Since fenoprofen is an NSAID with analgesic effects and can control implant-associated infection, we analyzed the effects of fenoprofen on the walking ability of mice with implant-associated osteomyelitis.…”

“…47,48 Orthopedic implant-associated infection impairs the patient's walking ability, which is caused by the pain and osteolysis resulting from the infection. 49 Since fenoprofen is an NSAID with analgesic effects and can control implant-associated infection, we analyzed the effects of fenoprofen on the walking ability of mice with implantassociated osteomyelitis.…”

Management of Periprosthetic Joint Infections After Hemiarthroplasty of the Hip

“…Del Toro et al demonstrated that 71% of patients who underwent HA and developed PJI had poor function, compared with 30% of patients who underwent THA 45 . In another series, PJI after hip HA was associated with an increased probability of using 2 crutches or being unable to walk independently (OR, 3.05 [95% CI, 1.01 to 9.20]; p = 0.047) compared with patients who developed PJI after THA 109 . Short-term mortality and long-term mortality are also markedly increased in this population.…”