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Symptomatic Benign Prostatic Hyperplasia: A Risk Factor for Periprosthetic Joint Infection in Male Patients
Hamidreza Yazdi1,2, Camilo Restrepo1, Carol Foltz1
1Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
Background:
Male patients undergoing total joint arthroplasty have a higher risk of periprosthetic joint infection (PJI) compared with female patients. The exact reason for this finding is not well known. This study aimed to determine if patients with symptomatic benign prostatic hyperplasia (BPH) are at increased risk of PJI.
Methods:
A total of 12,902 male patients who underwent primary or revision total joint arthroplasty from January 2006 to April 2017 were retrospectively identified. The mean patient age was 62.47 years and the mean patient body mass index was 30.1 kg/m. The majority of patients were Caucasian or African American. Most surgical procedures involved the hip joints (57.8%) and were primary arthroplasties (86%). Of these patients, 386 (3%) had symptomatic BPH. Among this group, 250 patients with symptomatic BPH were identified and were matched in an approximate 1:3 ratio with 708 control patients. Using the International Consensus Meeting criteria, patients who developed PJI were identified.
Results:
The PJI rate was 7.9% in the symptomatic BPH group and 2.8% in the control group. Multivariate regression analysis in unmatched groups showed that symptomatic BPH was a strong independent risk factor for PJI. After matching for variables related to outcomes, symptomatic BPH remained a significant risk factor for PJI (p = 0.01).
Conclusions:
Patients with symptomatic BPH had a higher risk of PJI compared with the control patients. This may partly explain the higher rate of PJI that is seen in male patients.
Level Of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Insights
Symptomatic benign prostatic hyperplasia (BPH) significantly increases the risk of periprosthetic joint infection (PJI) after total joint arthroplasty in male patients. This finding may help explain higher PJI rates observed in men.
Area of Science:
- Orthopedic Surgery
- Infectious Disease Epidemiology
- Urology
Background:
- Male patients exhibit a higher incidence of periprosthetic joint infection (PJI) following total joint arthroplasty compared to females.
- The underlying reasons for this disparity remain unclear.
- Benign prostatic hyperplasia (BPH) is a common condition in aging males, potentially influencing surgical outcomes.
Purpose of the Study:
- To investigate the association between symptomatic benign prostatic hyperplasia (BPH) and the risk of developing periprosthetic joint infection (PJI) in male patients undergoing total joint arthroplasty.
Main Methods:
- Retrospective analysis of 12,902 male patients undergoing primary or revision total joint arthroplasty (2006-2017).
- Patients were categorized based on the presence of symptomatic benign prostatic hyperplasia (BPH).
- Matched case-control analysis (approximately 1:3 ratio) comparing patients with symptomatic BPH to controls, with PJI diagnosis based on International Consensus Meeting criteria.
Main Results:
- The periprosthetic joint infection (PJI) rate was notably higher in the symptomatic BPH group (7.9%) compared to the control group (2.8%).
- Multivariate regression analysis identified symptomatic BPH as an independent risk factor for PJI.
- This association remained statistically significant after adjusting for potential confounding variables (p = 0.01).
Conclusions:
- Symptomatic benign prostatic hyperplasia (BPH) is a significant risk factor for periprosthetic joint infection (PJI) in male patients undergoing total joint arthroplasty.
- This increased risk associated with BPH may contribute to the higher PJI rates observed in the male population.
- Further research into BPH management strategies could potentially mitigate PJI risk.
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