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Development of a Preoperative Risk Calculator for Reinfection Following Revision Surgery for Periprosthetic Joint
Christian Klemt1, Venkatsaiakhil Tirumala1, Evan J Smith1
1Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Background:
A recent systematic review demonstrated that reinfection rates following eradication of hip and knee periprosthetic joint infection (PJI) may be as high as 29%. This study aimed to develop a preoperative risk calculator for assessing patient's individual risk associated with reinfection following treatment of PJI in total joint arthroplasty (TJA).
Methods:
A total of 1081 consecutive patients who underwent revision TJA for PJI were evaluated. In total, 293 patients were diagnosed with TJA reinfection. A total of 56 risk factors, including patient characteristics and surgical variables, were evaluated with multivariate regression analysis. Analysis of the area under the receiver operating characteristics curve was performed to evaluate the strength of the predictive model.
Results:
Of the 56 risk factors studied, 19 were found to have a significant effect as risk factor for TJA reinfection. The strongest predictors for TJA reinfection included previous PJI treatment techniques such as irrigation and debridement, the number of previous surgical interventions, medical comorbidities such as obesity, drug abuse, depression and smoking, as well as microbiology including the presence of Enterococcus species. The combined area under the receiver operating characteristics curve of the risk calculator for periprosthetic hip and knee joint reinfection was 0.75.
Conclusions:
The study findings demonstrate that surgical factors, including previous PJI surgical treatment techniques as well as the number of previous surgeries, alongside microbiology including the presence of Enterococcus species have the strongest effect on the risk for periprosthetic THA and TKA joint reinfection, suggesting the limited applicability of the existing risk calculators for the development of PJI following primary TJA in predicting the risk of periprosthetic joint reinfection.
Insights
Developing a risk calculator for periprosthetic joint infection (PJI) reinfection is crucial. Key predictors include surgical history, comorbidities, and specific bacteria like Enterococcus species, aiding in better patient risk assessment.
Area of Science:
- Orthopedic Surgery
- Infectious Disease
- Biostatistics
Background:
- Periprosthetic joint infection (PJI) following total joint arthroplasty (TJA) has high reinfection rates, up to 29%.
- Existing risk calculators for primary TJA may not accurately predict reinfection risk after PJI treatment.
Purpose of the Study:
- To develop a preoperative risk calculator for assessing individual patient risk of reinfection after PJI treatment.
- To identify significant risk factors for reinfection in revision TJA patients.
Main Methods:
- Systematic review of 1081 revision TJA patients for PJI.
- Multivariate regression analysis of 56 potential risk factors.
- Receiver operating characteristic (ROC) curve analysis to evaluate predictive model strength.
Main Results:
- 19 significant risk factors for TJA reinfection were identified.
- Strongest predictors include previous PJI treatments (irrigation/debridement), number of surgeries, comorbidities (obesity, drug abuse, depression, smoking), and Enterococcus species.
- The developed risk calculator achieved an area under the ROC curve of 0.75 for predicting reinfection.
Conclusions:
- Surgical factors and microbiology, particularly Enterococcus species, are the strongest predictors of PJI reinfection.
- Current risk calculators may have limited applicability for predicting reinfection in TJA patients.
- The developed risk calculator offers improved prediction of PJI reinfection risk.
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