Limiting the Surveillance Period to 90 Days Misses a Large Portion of Infections in the First Year After Total Hip and Knee Arthroplasty

Muscatelli, Stefano; Zheng, Hongxing; Muralidharan, Aditya; Tollemar, Viktor

doi:10.1016/j.artd.2022.04.009

Cited by 5 publications

(15 citation statements)

References 25 publications

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“…The JBI quality assessment showed that 6 [ 13 – 18 ] studies had a high risk bias, 8 [ 12 , 19 – 25 ] studies had a moderate risk bias, and 2 [ 14 , 26 ] studies had a low risk bias. The whole process was done by two researchers.…”

Section: Resultsmentioning

confidence: 99%

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Incidence of periprosthetic joint infection after primary total hip arthroplasty is underestimated: a synthesis of meta-analysis and bibliometric analysis

Zeng,

Yao,

et al. 2023

J Orthop Surg Res

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The American Musculoskeletal Society updated the diagnostic criteria for periprosthetic joint infection (PJI) in 2011 and 2018. However, the overall incidence of PJI since the introduction of these new standards has not been assessed. In order to fill this knowledge gap, a single-group meta-analysis was conducted using articles obtained from several databases, focusing on the incidence of PJI after primary total hip arthroplasty (THA). Our study revealed a significant difference in the incidence of PJI reported by different national or regional databases. Moreover, most cases of PJI were found to be underestimated. This highlights the crucial need for standardized diagnostic criteria and monitoring methods to accurately identify and track cases of PJI. Furthermore, a bibliometric analysis was conducted to provide a comprehensive overview of the current state of research on PJI after THA. This analysis explored the most productive countries, organizations, journals, and individuals in this research area. Additionally, it identified the research trends and hotspots of the last decade, highlighting the advancements and areas of focus in this field. By conducting these analyses, the study aims to contribute to the understanding of PJI after THA and provide valuable insights for clinicians, researchers, and policymakers involved in the management of this condition.

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Section: Resultsmentioning

confidence: 99%

“…2 and 3 . Estimates for the medical database-base studies [ 11 – 15 , 19 – 22 , 26 ] ranged from 0.34 to 2.45% (Fig. 2 ), and the random-effects overall pooled estimated incidence of PJI was 1.05% (95% CI 0.75–1.46%), with very high heterogeneity ( I 2 = 99.6%; heterogeneity test P = 0).…”

Section: Resultsmentioning

confidence: 99%

Incidence of periprosthetic joint infection after primary total hip arthroplasty is underestimated: a synthesis of meta-analysis and bibliometric analysis

Zeng,

Yao,

et al. 2023

J Orthop Surg Res

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“…The primary outcome was the 1-year revision rate for PJI, since a 2022 study from the US reported that limiting surveillance to 3 months misses more than 40% of infections in the first year after TKA. 33 Secondary outcomes were revision for PJI or all causes at 3 months and 1, 5, and 10 years.…”

Section: Outcome Variablesmentioning

confidence: 99%

Periprosthetic Joint Infection After Total Knee Arthroplasty With or Without Antibiotic Bone Cement

Leta,

Lie,

Fenstad

et al. 2024

JAMA Netw Open

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ImportanceDespite increased use of antibiotic-loaded bone cement (ALBC) in joint arthroplasty over recent decades, current evidence for prophylactic use of ALBC to reduce risk of periprosthetic joint infection (PJI) is insufficient.ObjectiveTo compare the rate of revision attributed to PJI following primary total knee arthroplasty (TKA) using ALBC vs plain bone cement.Design, Setting, and ParticipantsThis international cohort study used data from 14 national or regional joint arthroplasty registries in Australia, Denmark, Finland, Germany, Italy, New Zealand, Norway, Romania, Sweden, Switzerland, the Netherlands, the UK, and the US. The study included primary TKAs for osteoarthritis registered from January 1, 2010, to December 31, 2020, and followed-up until December 31, 2021. Data analysis was performed from April to September 2023.ExposurePrimary TKA with ALBC vs plain bone cement.Main Outcomes and MeasuresThe primary outcome was risk of 1-year revision for PJI. Using a distributed data network analysis method, data were harmonized, and a cumulative revision rate was calculated (1 − Kaplan-Meier), and Cox regression analyses were performed within the 10 registries using both cement types. A meta-analysis was then performed to combine all aggregated data and evaluate the risk of 1-year revision for PJI and all causes.ResultsAmong 2 168 924 TKAs included, 93% were performed with ALBC. Most TKAs were performed in female patients (59.5%) and patients aged 65 to 74 years (39.9%), fully cemented (92.2%), and in the 2015 to 2020 period (62.5%). All participating registries reported a cumulative 1-year revision rate for PJI of less than 1% following primary TKA with ALBC (range, 0.21%-0.80%) and with plain bone cement (range, 0.23%-0.70%). The meta-analyses based on adjusted Cox regression for 1 917 190 TKAs showed no statistically significant difference at 1 year in risk of revision for PJI (hazard rate ratio, 1.16; 95% CI, 0.89-1.52) or for all causes (hazard rate ratio, 1.12; 95% CI, 0.89-1.40) among TKAs performed with ALBC vs plain bone cement.Conclusions and RelevanceIn this study, the risk of revision for PJI was similar between ALBC and plain bone cement following primary TKA. Any additional costs of ALBC and its relative value in reducing revision risk should be considered in the context of the overall health care delivery system.

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“…Muscatelli et al report that limiting infection surveillance data out to only 90 days misses 23.22% of primary total hip infections and 42.33% of primary knee infections, with similar proportions reported for revisions [7]. They suggested that extension of surveillance period is a quality improvement opportunity [7]. Zalikha et al report that the "December effect" exists for arthroplasty, in that outcomes are better in this month than in others [8].…”

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confidence: 99%

“…In an interesting viewpoint article, Roof et al discuss the "hidden cost" of revisions [6], suggesting that a shift of revisions to centers of excellence may help cost and that aligning the work involved to the reimbursement would help incentive. Muscatelli et al report that limiting infection surveillance data out to only 90 days misses 23.22% of primary total hip infections and 42.33% of primary knee infections, with similar proportions reported for revisions [7]. They suggested that extension of surveillance period is a quality improvement opportunity [7].…”

mentioning

confidence: 99%

Midterm

Golladay¹

2022

Arthroplasty Today

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Limiting the Surveillance Period to 90 Days Misses a Large Portion of Infections in the First Year After Total Hip and Knee Arthroplasty

Cited by 5 publications

References 25 publications

Incidence of periprosthetic joint infection after primary total hip arthroplasty is underestimated: a synthesis of meta-analysis and bibliometric analysis

Incidence of periprosthetic joint infection after primary total hip arthroplasty is underestimated: a synthesis of meta-analysis and bibliometric analysis

Periprosthetic Joint Infection After Total Knee Arthroplasty With or Without Antibiotic Bone Cement

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