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Periprosthetic joint infections at a teaching hospital in 1990-2007
Alexandre Renaud1, Martin Lavigne, Pascal-André Vendittoli
1Centre de recherche Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Que.
Insights
Periprosthetic joint infections (PJIs) are serious complications. This study found that implementing new measures helped reduce infection rates for hip and knee replacements, achieving rates comparable to other centers.
Area of Science:
- Orthopedic Surgery
- Infectious Disease Epidemiology
- Healthcare Quality Improvement
Background:
- Periprosthetic joint infections (PJIs) represent a significant challenge in joint replacement surgery, leading to increased healthcare costs and patient morbidity.
- Evaluating infection rates is crucial for identifying areas of concern and implementing effective preventative strategies.
- This study focuses on hip and knee arthroplasty infections, comparing rates before and after the introduction of specific infection control measures.
Purpose of the Study:
- To assess the incidence of hip and knee periprosthetic joint infections (PJIs) at a single institution.
- To compare infection rates in the periods before (1990-2002) and after (2003-2007) the implementation of PJI reduction strategies.
- To identify risk factors associated with the development of PJIs.
Main Methods:
- Retrospective review of patient records for primary hip and knee total joint prostheses (1990-2007) with subsequent readmission for infection treatment.
- Inclusion of data from a prospective surveillance protocol for total hip arthroplasty (THA) and total knee arthroplasty (TKA) infections initiated in November 2005.
- Calculation of annual rates for deep, superficial, and hematogenous infections for both THA and TKA.
Main Results:
- A total of 2403 THAs and 1220 TKAs were performed during the study periods.
- Pre-intervention average infection rates were 2.0% (deep), 0.8% (superficial), and 0.3% (hematogenous) for THA, and 1.6% (deep), 0.7% (superficial), and 0.2% (hematogenous) for TKA.
- Following the implementation of infection control measures in 2003, a significant decrease in deep infection rates was observed: 44% for THA (2.5% to 1.4%) and 45% for TKA (2.0% to 1.1%).
- A high proportion (79.2%) of infected joints had identifiable risk factors.
Conclusions:
- Establishing baseline infection rates is vital for monitoring surgical outcomes and improving patient care.
- The implemented infection control measures were associated with a notable reduction in deep infection rates for both hip and knee arthroplasties.
- The achieved infection rates post-intervention are comparable to those reported by similar healthcare institutions, suggesting the effectiveness of the implemented strategies.
Background:
Periprosthetic joint infections (PJIs) are major complications associated with high costs and substantial morbidity. We sought to evaluate hip and knee arthroplasty infection rates at our hospital, compare them in periods before and after implementation of measures to reduce PJIs (1990-2002 and 2003-2007) and identify associated risk factors.
Methods:
We retrospectively reviewed records of patients who received primary hip or knee total joint prostheses at our centre between Jan. 1, 1990, and Dec. 31, 2007, and were readmitted for the treatment of infection related to their surgery. We also reviewed data from a prospective surveillance protocol of total hip (THA) and knee arthroplasty (TKA) infections that started in November 2005. We ascertained the annual rates of deep, superficial and hematogenous infections.
Results:
During the periods studied, 2403 THAs and 1220 TKAs were performed. For THA, the average rates of deep, superficial and hematogenous infections were 2.0%, 0.8% and 0.3%, respectively. For TKA, the rates were 1.6%, 0.7% and 0.2%, respectively. Of 106 infected joints, 84 (79.2%) presented risk factors for infection. Efforts to reduce the infection rate at our institution began in 2003. We achieved a 44% decrease in the deep infection rate for THA (2.5% v. 1.4%; p = 0.06) and a 45% decrease for TKA (2.0% v. 1.1%, p = 0.20) between the periods studied.
Conclusion:
Knowing the actual infection rate associated with different procedures in specific settings is essential to identify unexpected problems and seek solutions to improve patient care. Although we do not know what specific improvements were successful, we were able to decrease our infection rates to levels comparable to those reported by similar care centres.
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