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Development and Evaluation of a Preoperative Risk Calculator for Periprosthetic Joint Infection Following Total Joint
Timothy L Tan1, Mitchell G Maltenfort1, Antonia F Chen1
1Rothman Institute, Philadelphia, Pennsylvania.
Insights
A new risk calculator identifies patients at high risk for periprosthetic joint infection (PJI) after hip or knee replacement. This tool aids in optimizing patient care and preventing infections, especially those caused by Staphylococcus aureus or resistant organisms.
Area of Science:
- Orthopedic Surgery
- Infectious Disease Epidemiology
- Biostatistics
Background:
- Periprosthetic joint infection (PJI) is a significant complication following total hip arthroplasty (THA) and total knee arthroplasty (TKA).
- Preoperative risk stratification is crucial for patient optimization and targeted infection prevention strategies.
Purpose of the Study:
- To develop and validate a preoperative risk calculator for predicting the likelihood of PJI.
- To assess risk for any PJI, Staphylococcus aureus (S. aureus) PJI, and antibiotic-resistant organism PJI.
Main Methods:
- Retrospective review of 27,717 total joint arthroplasty (TJA) patients (2000-2014) with 1,035 PJI cases.
- Multivariate analysis of 42 potential risk factors, including patient and surgical variables.
- External validation using data from an independent institution (29,252 TJA patients).
Main Results:
- Identified 17 significant risk factors for PJI out of 42 evaluated.
- Key predictors included prior open surgery, drug abuse, revision procedures, and HIV/AIDS.
- Achieved strong predictive performance with Areas Under the Curve ranging from 0.73 to 0.86.
- Demonstrated a substantial increase in PJI rates from 0.56% in the lowest risk decile to over 15% in the highest.
Conclusions:
- Successfully developed and validated a preoperative risk calculator for PJI.
- Relative weights of risk factors like prior surgery and comorbidities are established.
- The tool can inform decisions regarding TJA indication and patient counseling.
Background:
Preoperative identification of patients at risk for periprosthetic joint infection (PJI) following total hip arthroplasty (THA) or total knee arthroplasty (TKA) is important for patient optimization and targeted prevention. The purpose of this study was to create a preoperative PJI risk calculator for assessing a patient's individual risk of developing (1) any PJI, (2) PJI caused by Staphylococcus aureus, and (3) PJI caused by antibiotic-resistant organisms.
Methods:
A retrospective review was performed of 27,717 patients (12,086 TKAs and 31,167 THAs), including 1,035 with confirmed PJI, who were treated at a single institution from 2000 to 2014. A total of 42 risk factors, including patient characteristics and surgical variables, were evaluated with a multivariate analysis in which coefficients were scaled to produce integer scores. External validation was performed with use of data on 29,252 patients who had undergone total joint arthroplasty (TJA) at an independent institution.
Results:
Of the 42 risk factors studied, 25 were found not to be significant risk factors for PJI. The most influential of the remaining 17 included a previous open surgical procedure, drug abuse, a revision procedure, and human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS). The areas under the curves were 0.83 and 0.84 for any PJI, 0.86 and 0.83 for antibiotic-resistant PJI, and 0.86 and 0.73 for S. aureus PJI in the internal and external validation models, respectively. The rates of PJI were 0.56% and 0.61% in the lowest decile of risk scores and 15.85% and 20.63% in the highest decile.
Conclusions:
In this large-cohort study, we were able to identify and validate risk factors and their relative weights for predicting PJI. Factors such as prior surgical procedures and high-risk comorbidities should be considered when determining whether TJA is indicated and when counseling patients.
Level Of Evidence:
Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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