The incidence of late prosthetic joint infections

Abstract

Background and purpose Late prosthetic joint infections (PJIs) are a growing medical challenge as more and more joint replacements are being performed and the expected lifespan of patients is increasing. We analyzed the incidence rate of late PJI and its temporal trends in a nationwide population.Patients and methods 112,708 primary hip and knee replacements performed due to primary osteoarthritis (OA) between 1998 and 2009 were followed for a median time of 5 (1–13) years, using data from nationwide Finnish health registries. Late PJI was detected > 2 years postoperatively, and very late PJI was detected > 5 years postoperatively.Results During the follow-up, involving 619,299 prosthesis-years, 1,345 PJIs were registered: cumulative incidence 1.20% (95% CI: 1.13–1.26) (for knees, 1.41%; for hips, 0.92%). The incidence rate of late PJI was 0.069% per prosthesis-year (CI: 0.061–0.078), and it was greater after knee replacement than after hip replacement (0.080% vs. 0.057%, p = 0.006). The incidence rate of very late PJI was 0.051% per prosthesis-year (CI: 0.042–0.063), 0.058% for knees and 0.044% for hips (p = 0.2). The incidence rate of late PJI varied between 0.041% and 0.107% during the years of observation without any temporal trend (incidence rate ratio (IRR) = 0.98, 95% CI: 0.93–1.03). Very late PJI increased from 0.026% in 2004 to 0.056% in 2010 (IRR = 1.11, 95% CI: 1.02–1.20).Interpretation In our nationwide study, the incidence rate of late PJI after hip or knee arthroplasty was approximately 0.07% per prosthesis-year. The incidence of very late PJI appeared to increase.

Competitive Surface Colonization of Antibacterial and Bioactive Materials Doped with Strontium and/or Silver Ions

“…The second method here named "prevention" was designed by an environment rich in bacteria to resemble the clinical scenario where the bone device is implanted into patients that present an infected anchorage site. For example, in orthopedics, this is the case of the peri-prosthetic joint infection (PJI), which is a condition affecting about 1% of patients carrying hip implants [34]. This condition requires complex and protracted treatments, sometimes leading to the need for an excision arthroplasty or amputation.…”

Description of the rates, trends and surgical burden associated with revision for prosthetic joint infection following primary and revision knee replacements in England and Wales: an analysis of the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man

“… 5–7 30 31 Studies that report incidence rates typically include any type of operations for the management of infection (not just those where implants are removed or changed) and this may be why they show higher rates (0.9%–1.4% between 1 and 5 years postoperatively). 6 32 …”

“… 4–7 In a study from Finland, about 1.14% of patients had a PJI within 2 years of their primary knee replacement with a further 0.27% of patients presenting with PJI later than 2 years after primary surgery. 6 After aseptic revision and more complex knee replacement surgeries, infection rates may be considerably higher. 8 There is a paucity of evidence from UK centres and the available studies are old and based on single-centre data.…”

Risk of infection in primary, elective total hip arthroplasty with direct anterior approach or lateral transgluteal approach: a prospective cohort study of 1104 hips

“…The reported infection rates depend on the definition of infection, the awareness of the surgeon, the quality of reporting, and the length of follow-up. In implant registers, there might be confounding factors, and data might be less reliable as compared to specific prospective infection registration [3, 5, 6]. …”