High Mortality in Patients Presenting With Periprosthetic Joint Infection and Concomitant Sepsis

Area of Science:

• Orthopedic Surgery
• Infectious Diseases
• Critical Care Medicine

Background:

• Periprosthetic joint infection (PJI) poses a significant mortality risk, comparable to some cancers.
• PJI can rapidly progress to life-threatening sepsis, complicating patient outcomes.

Purpose of the Study:

• To investigate the mortality rates of patients experiencing simultaneous PJI and sepsis following hip and knee arthroplasty.
• To compare outcomes between septic and non-septic PJI patients.

Main Methods:

• Retrospective chart review of 306 patients with PJI undergoing revision surgery between 2005 and 2022.
• Identification of septic patients based on systemic inflammatory response syndrome criteria and suspected/confirmed bacteremia.
• Analysis stratified by hip (121 patients) and knee (185 patients) arthroplasty, collecting demographic, comorbidity, and follow-up data.

Main Results:

• All-cause mortality was significantly higher in septic PJI patients (81.4%) compared to non-septic PJI patients (50.6%).
• One-year survival probability was lower for septic patients (77% knee, 42% hip) versus non-septic patients (92% knee, 93% hip).
• Increased age at admission correlated with higher mortality risk for both hip and knee PJI patients.

Conclusions:

• Simultaneous PJI and sepsis present a critical condition with a high mortality rate.
• The elevated mortality risk associated with PJI and sepsis persists even after accounting for age and comorbidities.