Does Body Mass Index Affect the Success of Two-Stage Management of Periprosthetic Joint Infection?

Area of Science:

• Orthopedic Surgery
• Infectious Disease
• Obesity Medicine

Background:

• Obesity is a known risk factor for complications following primary total joint arthroplasty.
• Periprosthetic joint infection (PJI) is a serious complication requiring revision surgery.
• The impact of varying degrees of obesity on PJI recurrence after two-stage revision is not fully understood.

Purpose of the Study:

• To investigate the association between body mass index (BMI) and infection recurrence after two-stage revision total joint arthroplasty for PJI.
• To analyze the relationship between BMI and reinfection rates, readmissions, and complications in PJI patients undergoing revision surgery.

Main Methods:

• Retrospective cohort analysis of patients undergoing two-stage revision for PJI.
• Patients were stratified into three BMI groups: non-obese (<30), obese (30-40), and morbidly obese (≥40).
• Outcomes assessed included PJI reinfection rates, timing of reinfection, 90-day readmission rates, and other complications.

Main Results:

• PJI reinfection rates significantly increased with BMI: 11.5% (non-obese), 19.0% (obese), and 25.9% (morbidly obese).
• Ninety-day readmission rates after two-stage PJI revision also rose with increasing BMI.
• The average time to reinfection decreased as BMI increased, indicating faster recurrence in more obese patients.

Conclusions:

• Patient BMI significantly impacts the success of PJI management via two-stage arthroplasty.
• Morbidly obese patients exhibit the poorest outcomes, with substantially higher rates of PJI recurrence.
• Considering BMI modification strategies before completing two-stage PJI treatment may be beneficial for morbidly obese individuals to reduce recurrence risk.