Risk Factors for Prosthetic Joint Infection: Case‐Control Study

Berbari, Elie F.; Hanssen, Arlen D.; Duffy, Mary C.; Steckelberg, James M.; Ilstrup, Duane M.; Harmsen, William S.; Osmon, Douglas R.

doi:10.1086/514991

Cited by 758 publications

(569 citation statements)

References 44 publications

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“…We did not confirm the findings of some study groups who reported an increased risk of deep infection in RA patients both in TKR and THR (13,16). Nor did we agree with Berbari et al (12), who reported no increased risk in TKR as well as THR (Table 3). …”

Section: Discussioncontrasting

confidence: 89%

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Risk of revision for infection in primary total hip and knee arthroplasty in patients with rheumatoid arthritis compared with osteoarthritis: A prospective, population‐based study on 108,786 hip and knee joint arthroplasties from the Norwegian Arthroplasty Register

Schrama¹,

Hallan²,

Engesæter³

et al. 2010

Arthritis Care & Research

181

106

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Objective. To compare differences in the risk of revision for infection and changes in risk over time and in time from primary surgery to revision for infection after total hip replacement (THR) and total knee replacement (TKR) in rheumatoid arthritis (RA) and osteoarthritis (OA) patients. Methods. In the Norwegian Arthroplasty Register, 6,629 and 102,157 primary total joint replacements in patients with RA and OA, respectively, were identified from 1987 (1994 for knees) until 2008. Survival analyses with revision due to infection as the end point were performed using Kaplan-Meier methods for constructing survival curves and multiple Cox regression to calculate relative risk (RR) estimates for diagnosis, age, sex, and year of primary surgery. An extended Cox model was used to estimate RR within different followup intervals. Results. RA patients with TKR had a 1.6 times higher risk of revision for infection than OA patients, whereas there was no difference in the THRs. In the THRs, we found a higher risk of revision for infection from 2001 onward, whereas the development for TKRs was the opposite. These time effects affected the RA and OA groups equally. The risk of revision for infection from 6 years postoperatively on was higher in RA patients. Conclusion. The overall risk of revision for infection after TKR was higher in RA patients. The risk of late infection leading to revision of the TKR and THR was higher in RA patients than in OA patients. After the year 2000, the RR of revision for infection in RA compared with OA remained unchanged.

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Section: Discussioncontrasting

confidence: 89%

“…There are conflicting reports on whether this increased baseline risk of infections in RA patients might influence the risk of deep infection after primary total joint replacement surgery (1,5,(11)(12)(13)(14)(15)(16)(17)(18).…”

Section: Introductionmentioning

confidence: 99%

Risk of revision for infection in primary total hip and knee arthroplasty in patients with rheumatoid arthritis compared with osteoarthritis: A prospective, population‐based study on 108,786 hip and knee joint arthroplasties from the Norwegian Arthroplasty Register

Schrama¹,

Hallan²,

Engesæter³

et al. 2010

Arthritis Care & Research

181

106

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“…Our findings, taken together with previous studies, suggest that surgeons should think carefully before performing this elective procedure in a patient with HbA 1C C 8 or FBG C 200 mg. Although no patients in our study developed deep infection, which prevents us from evaluating the association of poor glycemic control with deep infection, previous studies reported that patients who develop superficial surgical site infection are at greater risk for deep periprosthetic joint infection [3,24,26].…”

Section: Discussionmentioning

confidence: 62%

Do Glycemic Markers Predict Occurrence of Complications After Total Knee Arthroplasty in Patients With Diabetes?

Hwang

Kim

Bamne

et al. 2015

Clinical Orthopaedics &Amp; Related Research

109

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Background Patients with diabetes have increased risk of infections and wound complications after total knee arthroplasty (TKA). Glycemic markers identifying patients at risk for complications after TKA have not yet been elucidated. Questions/purposes We aimed to determine the correlations among four commonly used glycemic markers and to identify the glycemic markers most strongly associated with the occurrence of surgical site infections and postoperative wound complications in patients with diabetes mellitus after undergoing TKA. Methods Our retrospective study included 462 patients with diabetes, who underwent a total of 714 TKAs. Blood levels of glycemic markers, including preoperative fasting blood glucose (FBG), postprandial glucose (PPG2), glycated hemoglobin (HbA 1c ), and levels obtained from random glucose testing on postoperative days 2, 5, and 14, were collected on all patients as part of a medical clearance program and an established clinical pathway for patients with diabetes at our center. Complete followup was available on 93% (462 of 495) of the patients. Correlations among markers were assessed. Associations between the markers and patient development of complications were analyzed using multivariate regression analyses of relevant cutoff values. We considered any of the following as complications potentially related to diabetes, and these were considered study endpoints: surgical site infection (superficial and deep) and wound complications (drainage, hemarthrosis, skin necrosis, and dehiscence). During the period of study, there were no fixed criteria applied to what levels of glycemic control patients with diabetes needed to achieve before undergoing arthroplasty, and there were wide ranges in the levels of all glycemic markers; for example, whereas the mean HbA 1c level was 7%, the range was 5% to 11.3%.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 has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent was obtained. This work was performed at the Joint Reconstruction Center, Seoul National University Bundang Hospital, Seoul, Republic of Korea. Results There were positive correlations among the levels of the four glycemic markers; the strongest correlation was found between the preoperative HbA 1c and PPG2 levels (R = 0.502, p \ 0.001). After controlling for potential confounding variables using multivariate analysis, the HbA 1c cutoff level of 8 (odds ratio [OR], 6.1; 95% confidence interval...

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“…Some authors have suggested different adjunctive criteria [5,27,36,38] to overcome shortcomings of bacteriologic culture, leading to discrepancy in their inclusion and exclusion criteria. To resolve this inconsistency, an expert panel from the Musculoskeletal Infection Society (MSIS) has reviewed existing evidence and published a set of diagnostic criteria for PJI [30].…”

Section: Introductionmentioning

confidence: 99%

Diagnosis of Periprosthetic Joint Infection: The Threshold for Serological Markers

Alijanipour

Bakhshi

Parvızı

2013

Clinical Orthopaedics &Amp; Related Research

120

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Background Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) have recently been suggested as diagnostic criteria for periprosthetic joint infection (PJI) diagnosis. Thresholds for these markers should be reexamined since they have been determined arbitrarily. Questions/purposes Based on recently defined criteria for PJI, we determined (1) whether there is a difference in the threshold value of ESR and CRP between hips and knees, (2) whether the threshold value for ESR and CRP should be different for early-postoperative and late-chronic PJI, and (3) the optimal thresholds for ESR and CRP in PJI diagnosis. Methods We retrospectively reviewed 1962 patients with revision arthroplasty for aseptic failure (1095 hips, 594 knees) or first onset of PJI (108 hips, 165 knees) between 2000 and 2009. The PJI diagnosis was made independent of ESR and CRP using criteria recently proposed by the Musculoskeletal Infection Society. Patients with comorbidities that confound ESR and CRP were not included. Receiver operating characteristic (ROC) analysis was performed to determine thresholds. Results ESR and CRP levels in late-chronic PJI were higher in knees than in hips. Optimal thresholds for ESR and CRP were 48.5 mm/hour and 13.5 mg/L in hips and 46.5 mm/hour and 23.5 mg/L in knees, respectively. In early-postoperative PJI, ESR and CRP were similar in both joints with common thresholds of 54.5 mm/hour and 23.5 mg/L, respectively. Conclusions The data suggest a similar threshold for ESR but not for CRP should be implemented for late-chronic hips and knees. Optimal magnitudes are higher than conventional thresholds, indicating the need for refinement of thresholds if ESR and CRP are to be criteria for PJI diagnosis. Early-postoperative and late-chronic PJI might require different thresholds. Level of Evidence Level III, diagnostic study. See Instructions for Authors for a complete description of levels of evidence.

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Risk Factors for Prosthetic Joint Infection: Case‐Control Study

Cited by 758 publications

References 44 publications

Risk of revision for infection in primary total hip and knee arthroplasty in patients with rheumatoid arthritis compared with osteoarthritis: A prospective, population‐based study on 108,786 hip and knee joint arthroplasties from the Norwegian Arthroplasty Register

Risk of revision for infection in primary total hip and knee arthroplasty in patients with rheumatoid arthritis compared with osteoarthritis: A prospective, population‐based study on 108,786 hip and knee joint arthroplasties from the Norwegian Arthroplasty Register

Do Glycemic Markers Predict Occurrence of Complications After Total Knee Arthroplasty in Patients With Diabetes?

Diagnosis of Periprosthetic Joint Infection: The Threshold for Serological Markers

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