Related Experiment Video
Updated: Jun 14, 2025
Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
Published on: December 3, 2017
Microbiological Differences Among Age Groups in Patients Diagnosed With Periprosthetic Joint Infection: A Database
Seper Ekhtiari1, Franka Mai, Taner Karlidag
1From the Granovsky Gluskin Division of Orthopaedic Surgery, Sinai Health, University of Toronto, Toronto, Canada (Ekhtiari), the Marienhospital Gelsenkirchen, Gelsenkirchen, Germany (Mai), the Helios ENDO Klinik, Hamburg, Germany (Ekhtiari, Mai, Karlidag, Gehrke, and Citak), and the Royal College of Surgeons of Ireland (Ade-Conde).
Insights
Periprosthetic joint infection (PJI) risk profiles change with age after total joint arthroplasty (TJA). Older patients face higher rates of gram-negative and atypical infections, necessitating tailored prevention and treatment strategies.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Epidemiology
Background:
- Periprosthetic joint infection (PJI) following total joint arthroplasty (TJA) presents significant challenges.
- Global increases in hip and knee arthritis necessitate understanding age-specific PJI trends.
- The influence of patient age on PJI etiology and characteristics requires further investigation.
Purpose of the Study:
- To investigate the causative organisms of PJIs in patients undergoing TJA across different age groups.
- To analyze age-related differences in PJI characteristics, including infection type and antimicrobial resistance.
Main Methods:
- Retrospective cohort study of 2,392 patients undergoing revision TJA for PJI from 2001-2022.
- Patients categorized into age quintiles to analyze causative organisms, infection types, and resistance patterns.
- Statistical analyses included descriptive statistics and chi-square tests, with separate analyses for hip and knee arthroplasty.
Main Results:
- Older patients demonstrated a higher likelihood of gram-negative and atypical PJI pathogens.
- The youngest age group exhibited the lowest rates of methicillin-resistant Staphylococcus aureus (MRSA) infections.
- Observed trends in causative organisms and infection characteristics were consistent between hip and knee PJIs.
Conclusions:
- Age significantly influences PJI characteristics, with older individuals experiencing more complex infections.
- Findings highlight the need for age-tailored preventive strategies and potential adjustments in antibiotic therapy for elderly patients.
- Understanding age-specific PJI patterns is crucial for developing effective, individualized treatment and prevention approaches.
Introduction:
Periprosthetic joint infection (PJI) after total joint arthroplasty (TJA) poses substantial economic and quality-of-life challenges. With the rising incidence of hip and knee arthritis globally, understanding the changing profile of PJIs across different age groups becomes crucial. While various studies have explored risk factors, the influence of age on PJI remains debated, with potential bimodal relationships. This study aims to investigate the causative organisms of PJIs in patients of different age groups undergoing TJA.
Methods:
Conducted as a retrospective cohort study at a high-volume PJI referral center, the study adhered to Strengthening the Reporting of Observational Studies in Epidemiology guidelines. Data spanned from January 1, 2001, to December 31, 2022, including patients with documented PJI undergoing revision TJA. Patients were categorized into age quintiles, and outcomes analyzed included causative organisms, difficult-to-treat infections, antimicrobial resistance, and Gram stain characteristics. Statistical analyses used descriptive statistics, chi-square tests, and sensitivity analyses for hip and knee patients separately.
Results:
The study comprised 2,392 patients, with 60.7% undergoing hip arthroplasty and 39.3% undergoing knee arthroplasty. 1,080 women (45.2%) and 1,312 men (54.8%) were included. Older patients were markedly more likely to have gram-negative infections and atypical infections. Patients in the youngest age group had the lowest rates of methicillin-resistant Staphylococcus aureus infection. Results were similar between hip and knee PJIs.
Conclusions:
The study reveals age-related variations in the characteristics of PJIs after TJA, emphasizing higher risks of atypical and resistant infections in older patients. These findings underscore the importance of tailored preventive measures and potential considerations for adjunctive or prolonged antibiotic therapies, especially in the elderly population. Recognizing the unique infection patterns in older patients may inform better prevention and treatment strategies, with implications for enhanced patient care and outcomes. Future directions should focus on patient-specific strategies for preventing and treating PJIs, particularly in high-risk populations.
