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Synchronous Periprosthetic Joint Infections: High Mortality, Reinfection, and Reoperation
Elizabeth B Gausden1, Mark W Pagnano1, Kevin I Perry1
1Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.
Background:
Synchronous periprosthetic joint infections (PJIs) are a catastrophic complication with potentially high mortality. We aimed to report mortality, risk of reinfection, revision, reoperation, and implant survivorship after synchronous PJIs.
Methods:
We identified 34 patients treated for PJI in more than one joint within a single 90-day period from 1990 to 2018. PJIs involved bilateral knee arthroplasty (27), bilateral hip arthroplasty (4), 1 knee arthroplasty and 1 elbow arthroplasty (1), 1 knee arthroplasty and 1 shoulder arthroplasty (1), and bilateral hip and knee arthroplasty (1). Irrigation and debridement with component retention was performed in 23 patients, implant resection in 10 patients, and a combination of irrigation and debridement with component retention and implant resection in 1 patient. A competing risk model was used to analyze implant survivorship, and Kaplan-Meier survival was used for patient mortality. Mean follow-up was 6 years.
Results:
Mortality was high at 18% at 30 days and 27% at 1 year. The 1-year cumulative incidence of any reinfection was 13% and 27% at 5 years. The 1-year cumulative incidence of any revision or implant removal was 6% and 20% at 5 years. The 1-year cumulative incidence of unplanned reoperation was 25% and 35% at 5 years. Rheumatoid arthritis was associated with increased risk of mortality (HR 7, P < .01), as was liver disease (HR 4, P = .02).
Conclusion:
In the largest series to date, patients with synchronous PJIs had a high 30-day mortality rate of 18%, and one-fourth underwent unplanned reoperation within the first year.
Insights
Synchronous periprosthetic joint infections (PJIs) are serious, leading to high mortality and frequent reoperations. Early recognition and management are crucial for improving outcomes in these complex cases.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Arthroplasty Research
Background:
- Synchronous periprosthetic joint infections (PJIs) represent a severe complication following joint replacement surgery.
- These infections, affecting multiple joints simultaneously, carry a significant risk of mortality and morbidity.
Purpose of the Study:
- To evaluate the mortality rates associated with synchronous PJIs.
- To determine the risks of reinfection, revision surgery, and reoperation after synchronous PJIs.
- To assess implant survivorship in patients with synchronous PJIs.
Main Methods:
- A retrospective review of 34 patients diagnosed with synchronous PJIs between 1990 and 2018.
- Analysis of infection sites including bilateral knees, hips, and combinations with other joints.
- Surgical interventions included irrigation and debridement with component retention or implant resection.
Main Results:
- High 30-day mortality (18%) and 1-year mortality (27%) were observed.
- The 5-year cumulative incidence of reinfection was 27%, and implant removal was 20%.
- Rheumatoid arthritis and liver disease were identified as risk factors for increased mortality.
Conclusions:
- Synchronous PJIs are associated with substantial short-term mortality and a high likelihood of requiring further surgical intervention.
- A significant proportion of patients experienced unplanned reoperations within the first year post-diagnosis.
- This study highlights the critical nature of synchronous PJIs and the need for effective management strategies.
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