Risk factors for prosthetic joint infections following total hip arthroplasty based on 33,337 hips in the Finnish Arthroplasty Register from 2014 to 2018

Panula, Valtteri J.; Alakylä, Kasperi J.; Venäläinen, Mikko S; Haapakoski, Jaason; Eskelinen, Antti; Manninen, Mikko; Kettunen, Jukka; Puhto, Ari‐Pekka; Vasara, Anna; Elo, Laura L.; Mäkelä, Keijo

doi:10.1080/17453674.2021.1944529

Cited by 18 publications

(11 citation statements)

References 40 publications

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“…The relationship between BMI and risk of infection was not linear; either a high or a low BMI might be associated with increased infection risk 35 . We have noted simultaneous bilateral TJA to be a risk factor for PJI, which was consistent with several large-scale studies 36 , 37 . However, regarding the risk of infection events, the choice between a staged or simultaneous bilateral TJA procedure remains controversial 38 , 39 .…”

Section: Discussionsupporting

confidence: 92%

Pharmacological thromboprophylaxis as a risk factor for early periprosthetic joint infection following primary total joint arthroplasty

Pai

Chang

Tsai

et al. 2022

Sci Rep

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Venous thromboembolism (VTE) prophylaxis has been suggested for patients who underwent total join arthroplasty (TJA). However, the morbidity of surgical site complications (SSC) and periprosthetic joint infection (PJI) has not been well evaluated. We aimed to evaluate the impact of VTE prophylaxis on the risk of early postoperative SSC and PJI in a Taiwanese population. We retrospectively reviewed 7511 patients who underwent primary TJA performed by a single surgeon from 2010 through 2019. We evaluated the rates of SSC and PJI in the early postoperative period (30-day, 90-day) as well as 1-year reoperations. Multivariate regression analysis was used to identify possible risk factors associated with SSC and PJI, including age, sex, WHO classification of weight status, smoking, diabetes mellitus (DM), rheumatoid arthritis(RA), Charlson comorbidity index (CCI), history of VTE, presence of varicose veins, total knee or hip arthroplasty procedure, unilateral or bilateral procedure, or receiving VTE prophylaxis or blood transfusion. The overall 90-day rates of SSC and PJI were 1.1% (N = 80) and 0.2% (N = 16). VTE prophylaxis was a risk factor for 90-day readmission for SSC (aOR: 1.753, 95% CI 1.081–2.842), 90-day readmission for PJI (aOR: 3.267, 95% CI 1.026–10.402) and all 90-day PJI events (aOR: 3.222, 95% CI 1.200–8.656). Other risk factors included DM, underweight, obesity, bilateral TJA procedure, younger age, male sex and RA. Pharmacological thromboprophylaxis appears to be a modifiable risk factor for SSC and PJI in the early postoperative period. The increased infection risk should be carefully weighed in patients who received pharmacological VTE prophylaxis.

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Section: Discussionsupporting

confidence: 92%

Pharmacological thromboprophylaxis as a risk factor for early periprosthetic joint infection following primary total joint arthroplasty

Pai

Chang

Tsai

et al. 2022

Sci Rep

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Section: Discussionmentioning

confidence: 99%

“…ASA classification is a crude estimate of a patient’s medical condition and a high score has been associated with the risk of PJI in numerous reports 11 12. For instance, Blanco et al reported a 15-fold OR (95% CI: 6.54 to 35.80) for PJI in patients with ASA classification≥3 31 and Panula et al presented an HR of 3.2 (95% CI: 2.0 to 5.1) for the same ASA classification 32…”

Section: Discussionmentioning

confidence: 99%

“…11 12 For instance, Blanco et al reported a 15-fold OR (95% CI: 6.54 to 35.80) for PJI in patients with ASA classification≥3 31 and Panula et al presented an HR of 3.2 (95% CI: 2.0 to 5.1) for the same ASA classification. 32 A recent meta-analysis showed that male sex was a risk factor for PJI development, especially after TKA. 19 In our analysis, male sex was close to a significant risk factor for progression from SSSI into PJI, both as a single variable and after adjustment for all covariates (2.8 times higher risk for men than women).…”

Section: Patient-related Risk Factors For the Development Of Deep Sur...mentioning

confidence: 99%

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Patient-related factors associated with superficial surgical site infection and progression to a periprosthetic joint infection after elective primary total joint arthroplasty: a single-centre, retrospective study in Sweden

Eriksson

Lazarinis

2022

BMJ Open

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ObjectivesSuperficial surgical site infection (SSSI) may increase the risk of serious complications such as periprosthetic joint infection (PJI). This study aims to identify patient-related risk factors associated with SSSI and investigate their correlation with the progression of PJI.DesignIn this retrospective study, 1191 elective hip and knee prostheses were included. Patients were interviewed 3–5 months after surgery to answer questions about the postoperative period. Patient records were reviewed to determine whether there had been any documentation of wound-healing difficulties or whether antibiotics were prescribed to treat an infection related to arthroplasty surgery.SettingUppsala University Hospital, patients treated between November 2008 and December 2012.ParticipantsThe study population comprised 433 knees and 758 hips.Outcome measuresWe studied patient-related risk factors (joint, age, sex, the American Society of Anesthesiologists (ASA) classification, body mass index (BMI), smoking, diabetes and rheumatic disease) to determine whether they were associated with (1) SSSI and (2) the progress from SSSI to PJI.Results84 (7%) patients of the total cohort developed SSSI. This infection progressed to a PJI in 24 (29%) of the patients. Factors with increased adjusted risk ratios (aRRs) for SSSIs were knee surgery (1.7; 95% CI: 1.1 to 2.7), age≥65 years (1.7; 95% CI: 1.1 to 2.8), BMI≥30 (1.9; 95% CI: 1.0 to 3.4) and ASA classification≥3 (1.7; 95% CI: 1.0 to 2.9). ASA classification≥3 was the only factor showing a significant progression from SSSI to PJI (aRR=3.3; 95% CI: 1.0 to 10.3).ConclusionsThe risk of progressing from an SSSI to a PJI is high. Older patients, patients with obesity, and those with a high ASA classification considered for elective total knee arthroplasty seem to have an increased risk of developing SSSI. Patients with a high ASA classification seem to have an increased risk of progressing from SSSI to PJI.

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“…The content of the Finnish Arthroplasty Register (FAR) ( 1 ) was revised in 2014 to include new parameters such as BMI, anesthesia mode, use of kinematic alignment, use of an antimicrobial incise drape, and surgical approach. We have previously reported on risk factors for PJI after THA in Finland ( 13 ), but PJI risk factors after primary condylar TKA have not previously been assessed systematically. In 2020 the total number of primary TKAs in Finland was 12,692 and of revision TKAs 1,015 (including repeated surgery), 30% of which were for PJI ( 1 ).…”

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confidence: 99%

Risk factors for revision due to prosthetic joint infection following total knee arthroplasty based on 62,087 knees in the Finnish Arthroplasty Register from 2014 to 2020

Keemu

Alakylä

Клен

et al. 2023

ActaO

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Background and purpose: Periprosthetic joint infection (PJI) is the commonest reason for revision after total knee arthroplasty (TKA). We assessed the risk factors for revision due to PJI following TKA based on the Finnish Arthroplasty Register (FAR). Patients and methods: We analyzed 62,087 primary condylar TKAs registered between June 2014 and February 2020 with revision for PJI as the endpoint. Cox proportional hazards regression was used to estimate hazard ratios (HR) with 95% confidence intervals (CI) for the first PJI revision using 25 potential patient- and surgical-related risk factors as covariates.Results: 484 knees were revised for the first time during the first postoperative year because of PJI. The HRs for revision due to PJI in unadjusted analysis were 0.5 (0.4–0.6) for female sex, 0.7 (0.6–1.0) for BMI 25–29, and 1.6 (1.1–2.5) for BMI > 40 compared with BMI < 25, 4.0 (1.3–12) for preoperative fracture diagnosis compared with osteoarthritis, and 0.7 (0.5–0.9) for use of an antimicrobial incise drape. In adjusted analysis the HRs were 2.2 (1.4–3.5) for ASA class III–IV compared with class I, 1.7 (1.4–2.1) for intraoperative bleeding ≥ 100 mL, 1.4 (1.2–1.8) for use of a drain, 0.7 (0.5–1.0) for short duration of operation of 45–59 minutes, and 1.7 (1.3–2.3) for long operation duration > 120 min compared with 60–89 minutes, and 1.3 (1.0–1.8) for use of general anesthesia.Conclusion: We found increased risk for revision due to PJI when no incise drape was used. The use of drainage also increased the risk. Specializing in performing TKA reduces operative time and thereby also the PJI rate.

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Risk factors for prosthetic joint infections following total hip arthroplasty based on 33,337 hips in the Finnish Arthroplasty Register from 2014 to 2018

Cited by 18 publications

References 40 publications

Pharmacological thromboprophylaxis as a risk factor for early periprosthetic joint infection following primary total joint arthroplasty

Pharmacological thromboprophylaxis as a risk factor for early periprosthetic joint infection following primary total joint arthroplasty

Patient-related factors associated with superficial surgical site infection and progression to a periprosthetic joint infection after elective primary total joint arthroplasty: a single-centre, retrospective study in Sweden

Risk factors for revision due to prosthetic joint infection following total knee arthroplasty based on 62,087 knees in the Finnish Arthroplasty Register from 2014 to 2020

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