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Have We Succeeded in Reducing the 2-Year Periprosthetic Joint Infection Incidence Rate Following Total Hip
Philip M Parel1, Anthony K Chiu1, Amy Y Zhao2
1Department of Orthopaedic Surgery, The George Washington University Hospital, Washington, District of Columbia.
Background:
Current clinical practice guidelines to reduce periprosthetic joint infection following total hip arthroplasty (THA) advocate for preventative methods including preoperative antibiotics, nasal decolonization, meticulous antiseptic preparation, and preoperative risk stratification. However, it remains unclear if the implementation of these methods has impacted the incidence of septic revision following THA. Therefore, the purpose of this study was to examine the change in the 2-year incidence rate of septic revisions following THA from 2011 to 2019.
Methods:
A retrospective observational study was performed using a national administrative claims database. The primary outcome was to observe the yearly change in the rates of 2-year incidence of septic revision after THA from 2011 to 2019. Multivariable logistic regression was conducted to compare the incidence of septic revision for each year, using 2011 as the reference year. A linear regression analysis and compounded annual growth rate calculation were conducted to assess the change throughout the study period.
Results:
In total, 412,586 patients underwent THA from 2011 to 2019, with an overall 0.4% undergoing septic revision within 2 years following THA. The rate of septic revision increased from 0.3% in 2011 to 0.5% in 2019 (compounded annual growth rate: +6.6%; P < 0.001). After controlling for confounders, comparing the yearly rates to that in 2011, the likelihood of septic revision surgery sequentially increased in 2015 (odds ratio (OR): 1.34), 2016 (OR: 1.33), 2017 (OR: 1.46), 2018 (OR: 1.47), and 2019 (OR: 1.70) (P < 0.05 for all).
Conclusions:
Although studies have shown various infectious control modalities to be efficacious in reducing the incidence of septic revision, our study of patients on a national level demonstrates an increase in the rate of 2-year septic revision. Future efforts may focus on creating more targeted prevention strategies against periprosthetic joint infection with recent trends in mind.
