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Updated: Jun 25, 2026
Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
Published on: December 3, 2017
Periprosthetic Joint Infection Mortality After Total Hip Arthroplasty Is Comparable to 5-Year Rates of Common
Michael S Ramos1, Brian Benyamini1, Varun Kompala1
1Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio.
Background:
Periprosthetic joint infection (PJI) after total hip arthroplasty (THA) is a rare, but devastating complication with elevated morbidity and mortality. While associated with increased mortality, the reported range is broad and most often reported after 2-stage exchange arthroplasty. This study aimed to report the overall mortality after PJI following primary THA, PJI mortality at one, three, and 12 months, and mortality after common PJI treatments. We hypothesized that mortality after THA PJI would be high, increase over time, and be highest after a 2-stage exchange.
Methods:
A meta-analysis of articles from six databases, queried from inception to December 2023, was performed. Full-length articles reporting mortality following PJI after primary THA were included. Articles with oncologic, infectious, or traumatic THA indications were excluded. Articles investigating high-risk patient populations, including those who had solid organ transplants, active cancer diagnoses, and synchronous PJI, were excluded. There were two independent reviewers who reviewed articles. Mortality over time and after treatment (debridement, antibiotics, and implant retention, 1-stage, and 2-stage exchange arthroplasty) was collected. A meta-analysis of proportions with inverse-variance proportion models was constructed for overall mortality.
Results:
A total of 19,917 patients who had PJI after THA from 20 studies were included. Overall mortality was 11.0% (95% CI [confidence interval]: five to 18.8) at a mean follow-up of 40.3 months (range, one to 240). Pooled mortality at one, three, and 12 months was 1.1, 3.7, and 10.0%, respectively. Mortality following treatment with debridement, antibiotics, and implant retention, 1-stage, and 2-stage exchange was 7.8% (95% CI: 2.3 to 15.9), 1.6% (95% CI: 0 to 14), and 9.2% (95% CI: 5.4 to 13.9), respectively. Considerable heterogeneity was present.
Conclusions:
Mortality after THA PJI is high (11.0%) within three years of arthroplasty and comparable to 5-year rates of cancers, such as breast (11%) and prostate (1%) cancers. A multidisciplinary approach, like those adopted in the treatment of cancer, is warranted to reduce the burden of this devastating complication.
