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Published on: December 3, 2017
Single, Recurrent, Synchronous, and Metachronous Periprosthetic Joint Infections in Patients With Multiple Hip and
Jonathan J Lee1, Kingsley Oladeji2, Brian F Sweeney3
1Department of Orthopaedic Surgery, Stanford University, Redwood City, California; Stanford University School of Medicine, Stanford, California.
Background:
The rate for periprosthetic joint infection (PJI) exceeds 1% for primary arthroplasties. Over 30% of patients who have a primary arthroplasty require an additional arthroplasty, and the impact of PJI on this population is understudied. Our objective was to assess the prevalence of recurrent, synchronous, and metachronous PJI in patients who had multiple arthroplasties and to identify risk factors for a subsequent PJI.
Methods:
We identified 337 patients who had multiple arthroplasties and at least 1 PJI that presented between 2003 and 2021. The mean follow-up after revision arthroplasty was 3 years (range, 0 to 17.2). Patients who had multiple infected prostheses were categorized as synchronous (ie, presenting at the same time as the initial infection) or metachronous (ie, presenting at a different time as the initial infection). The PJI diagnosis was made using the MusculoSkeletal Infection Society (MSIS) criteria.
Results:
There were 39 (12%) patients who experienced recurrent PJI in the same joint, while 31 (9%) patients developed PJI in another joint. Positive blood cultures were more likely in the second joint PJI (48%) compared to recurrent PJI (23%) or a single PJI (15%, P < .001). Synchronous PJI represented 42% of the second joint PJI cases (n = 13), while metachronous PJI represented 58% (n = 18). Tobacco users had 75% higher odds of metachronous PJI (odds ratio 1.75, 95% confidence interval: 1.1-2.9, P = .041).
Conclusion:
Over 20% of the patients with multiple arthroplasties and a single PJI will develop a subsequent PJI in another arthroplasty with 12% recurring in the initial arthroplasty and nearly 10% ocurring in another arthroplasty. Particular caution should be taken in patients who use tobacco, have bacteremia, or have Staphylococcus aureus isolation at time of their initial PJI. Optimizing the management of this high-risk patient population is necessary to reduce the additional burden of subsequent PJI.
Level Of Evidence:
Prognostic Level IV.
Insights
Over 20% of patients with multiple joint replacements develop a subsequent periprosthetic joint infection (PJI), with 12% recurring and 10% occurring in new joints. Tobacco use and bacteremia are key risk factors for PJI.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Epidemiology
Background:
- Periprosthetic joint infection (PJI) rates exceed 1% for primary arthroplasties.
- Over 30% of patients require revision arthroplasty, with the impact of PJI understudied in this group.
- Understanding recurrent and new PJIs is crucial for managing patients with multiple arthroplasties.
Purpose of the Study:
- To assess the prevalence of recurrent, synchronous, and metachronous PJI in patients with multiple arthroplasties.
- To identify risk factors associated with developing a subsequent PJI after an initial infection.
- To inform management strategies for high-risk patients undergoing multiple joint replacements.
Main Methods:
- Retrospective identification of 337 patients with multiple arthroplasties and at least one PJI (2003-2021).
- Classification of PJIs as synchronous (same time) or metachronous (different time) relative to the initial infection.
- Diagnosis of PJI based on established MusculoSkeletal Infection Society (MSIS) criteria.
Main Results:
- 12% of patients experienced recurrent PJI in the same joint, and 9% developed PJI in a different joint.
- Positive blood cultures were more frequent in second joint PJIs (48%) compared to recurrent (23%) or single PJIs (15%).
- Tobacco users showed a 75% increased odds of developing metachronous PJI (OR 1.75).
Conclusions:
- Over 20% of patients with multiple arthroplasties and a prior PJI will experience a subsequent infection.
- Patients with tobacco use, bacteremia, or Staphylococcus aureus isolation are at higher risk.
- Targeted management strategies are essential to mitigate the burden of subsequent PJIs in this population.
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