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Published on: December 3, 2017
Risk factors for metachronous periprosthetic joint infection in patients with multiple prosthetic joints: a
Yi Li1, Xiaolin Quan2, Cheng Zhou2
1Department of Orthopaedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxue Road, Wuhou District, Chengdu, 610041, China.
Object:
Although periprosthetic joint infection (PJI) can affect multiple joints simultaneously, most individuals with multiple joint involvement exhibit PJI in only one joint. Data regarding the metachronous PJI management for these patients are limited. This study aimed to explore the risk factors for metachronous PJI in patients with multiple prosthetic joints, thereby guiding and optimizing clinical practice.
Methods:
The MEDLINE, Web of Science, Cochrane Library, and EMBASE were searched for all clinical studies of metachronous PJI from inception until May 2024. The clinical studies on risk factors for metachronous PJI in patients with multiple prosthetic joints after experiencing a periprosthetic infection were collected, with two authors independently screening the literatures. Newcastle Ottawa scale was used as a quality assessment tool for the included studies, and the meta-analysis was conducted to evaluate the potential risk factors of metachronous PJI.
Results:
A total of 1,544 patients with PJI after multiple joint arthroplasties were reported in 9 studies, including 189 with metachronous PJI. The meta-analysis showed that methicillin-resistant staphylococcus aureus (MRSA; OR, 3.43; 95%CI, 1.71-6.88; p = 0.0005), rheumatoid arthritis (RA; OR, 2.38; 95%CI, 1.06-5.38; p = 0.04), history of steroid use (OR, 2.93; 95%CI, 1.58-5.43; p = 0.0007), and previous or ongoing non-periprosthetic infection (OR, 4.47; 95%CI, 1.45-13.82; p = 0.009) were identified as significant risk factors for metachronous PJI in patients with multiple prosthetic joints. However, there was no significant difference between the metachronous PJI group and non-metachronous group in terms of revision, age, diabetes, and gender.
Conclusion:
Patients with MRSA, RA, history of steroid use, previous or ongoing non-periprosthetic infection are at significantly higher risk for metachronous PJI. Further research is needed to optimize management strategies for preventing metachronous PJI in patients with multiple prostheses after a single joint PJI.
Insights
Patients with multiple prosthetic joints are at higher risk for a second periprosthetic joint infection (PJI) if they have methicillin-resistant Staphylococcus aureus (MRSA), rheumatoid arthritis (RA), a history of steroid use, or other infections. Identifying these risk factors can help prevent metachronous PJI.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Rheumatology
Background:
- Periprosthetic joint infection (PJI) can affect multiple joints, but data on metachronous PJI in patients with multiple prostheses are limited.
- Understanding risk factors for metachronous PJI is crucial for optimizing clinical management and prevention strategies.
Purpose of the Study:
- To explore risk factors for metachronous periprosthetic joint infection (PJI) in patients with multiple prosthetic joints.
- To guide and optimize clinical practice for managing patients at risk of developing PJI in a second joint.
Main Methods:
- A systematic literature search was conducted across MEDLINE, Web of Science, Cochrane Library, and EMBASE up to May 2024.
- Meta-analysis was performed on 9 clinical studies involving 1,544 patients to identify significant risk factors for metachronous PJI.
Main Results:
- Methicillin-resistant Staphylococcus aureus (MRSA), rheumatoid arthritis (RA), history of steroid use, and prior/ongoing non-periprosthetic infections were significant risk factors for metachronous PJI.
- No significant differences were found regarding revision, age, diabetes, or gender between metachronous and non-metachronous PJI groups.
Conclusions:
- Patients with MRSA, RA, history of steroid use, or other infections face a substantially higher risk of metachronous PJI.
- Further research is essential to develop effective management and prevention strategies for metachronous PJI in patients with multiple prostheses.
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