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Predictors of Reinfection in Prosthetic Joint Infections Following Two-Stage Reimplantation
Curtis W Hartman1, Eric C Daubach1, Brian T Richard1
1Department of Orthopaedic Surgery, The University of Nebraska Medical Center, Omaha, NE.
Background:
Two-stage reimplantation is an effective treatment for periprosthetic joint infection (PJI). Many factors are involved in the variable success of this procedure. The purpose of this study is to examine the relationship between patient risk factors, comorbidities, and the pathogen on reinfection rates following two-stage reimplantation.
Methods:
We evaluated 158 patients treated for PJI from 2008-2019. Only patients who had completed a two-stage exchange were included. Patient demographics, comorbidities, laboratory values, time-to-reimplantation, pathogen, antibiotic sensitivities, host status, and reinfection rates were assessed. Multivariate analysis was performed to identify correlation between risk factors and reinfection. A P-value < .05 was considered statistically significant.
Results:
31 patients experienced a reinfection (19.6%). There was a statistically significant association between infection with Methicillin Sensitive Staphylococcus Aureus (MSSA) and reinfection (P = .046). Patients with a reinfection also had a significantly greater median serum C-reactive protein (CRP) level (12.65 g/dL) at the time of diagnosis compared to patients without a reinfection (5.0 g/dL) (P = .010). Median Erythrocyte Sedimentation Rate (ESR) (56 in no re-infection and 69 in re-infection) and time-to-reimplantation (101 days in no reinfection and 141 days in reinfection) demonstrated a trend toward an association with re-infection but were not statistically significant (P = .055 and P = .054 respectively).
Conclusion:
As the number of arthroplasties continue to rise, PJIs are increasing proportionately and represent a significant revision burden. Elevated C-reactive protein (CRP) levels and Methicillin Sensitive Staphylococcus aureus (MSSA) infection were strongly associated with failure of a two-stage reimplantation. While not statistically significant with our numbers, there were strong trends toward an association between elevated Erythrocyte Sedimentation Rate (ESR), longer time-to-reimplantation, and reinfection.
Insights
Peripiprosthetic joint infection (PJI) treatment success in two-stage reimplantation is linked to specific patient factors. Methicillin-sensitive Staphylococcus aureus (MSSA) infection and elevated C-reactive protein (CRP) levels significantly increase reinfection risk.
Area of Science:
- Orthopedic surgery
- Infectious disease
- Biomaterials science
Background:
- Peripiprosthetic joint infection (PJI) is a significant complication following joint replacement surgery.
- Two-stage reimplantation is a common surgical approach for managing PJI.
- Factors influencing the success of two-stage reimplantation require further investigation.
Purpose of the Study:
- To investigate the relationship between patient risk factors, comorbidities, and specific pathogens and reinfection rates after two-stage reimplantation for PJI.
- To identify key predictors of treatment failure in PJI management.
Main Methods:
- A retrospective review of 158 patients who underwent two-stage reimplantation for PJI between 2008 and 2019.
- Analysis of patient demographics, comorbidities, laboratory values (CRP, ESR), time to reimplantation, causative pathogen, and antibiotic sensitivities.
- Multivariate analysis to determine statistically significant correlations between risk factors and reinfection rates (P < .05).
Main Results:
- The overall reinfection rate was 19.6% (31/158 patients).
- Infection with Methicillin-sensitive Staphylococcus aureus (MSSA) was significantly associated with higher reinfection rates (P = .046).
- Patients experiencing reinfection had significantly higher median serum C-reactive protein (CRP) levels at diagnosis (12.65 g/dL vs. 5.0 g/dL, P = .010).
Conclusions:
- Elevated CRP levels and MSSA infection are significant risk factors for failure in two-stage reimplantation for PJI.
- Trends suggest that elevated Erythrocyte Sedimentation Rate (ESR) and longer time to reimplantation may also contribute to reinfection, though not statistically significant in this cohort.
- These findings highlight the importance of identifying and managing specific patient and pathogen-related factors to optimize PJI treatment outcomes.
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