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

Periprosthetic joint infection (PJI) has a 5-year mortality rate comparable to many cancers and can progress to a life-threatening sepsis. The aim of this study was to investigate the mortality of patients presenting with simultaneous PJI and sepsis after hip and knee arthroplasty.

A retrospective chart review was performed on patients from an academic center between 2005 and 2022. Patients who underwent total joint arthroplasty, developed PJI, and presented for revision were identified. Septic patients met two or more systemic inflammatory response syndrome criteria and had suspected or confirmed bacteremia. The study included 306 admitted patients who had PJI. On admission, 43 patients (14%) had sepsis, while 263 did not (85.9%). The analysis was divided by knee or hip procedure, with 121 hip patients and 185 knee patients. Patient demographics, comorbidities, complications, and follow-up data were collected. Descriptive and univariate statistical analyses were conducted.

The all-cause mortality rate during follow-up was 35 of 43 (81.4%) in patients who presented with sepsis versus 133 of 263 (50.6%) in patients who presented without sepsis. The estimated probability of survival up to one year for septic patients was 77% (95% confidence interval (CI): 63 to 94) versus 92% for nonseptic patients (95% CI: 87 to 96) for knee patients and 42% (95% CI: 23 to 81) versus 93% (95% CI: 89 to 98) for hip patients. Each 10-year increase in age at time of admission is associated with a 29% increase in the risk of all-cause mortality (hazard ratio = 1.29, 95% CI: 1.08 to 1.45; P = 0.005) for hip patients and a 44% increase for knee patients (hazard ratio = 1.44 95% CI: 1.25 to 1.64; P = 0.000007).

Simultaneous PJI and sepsis is associated with a high mortality rate, even after adjusting for age and comorbidities.