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Surgical Approach and Microbiologic Trends in Hip Periprosthetic Joint Infection: A Retrospective Comparison of
John R Tyler1, Daniel Schmitt, William J Long
1From the Department of Orthopaedic Surgery & Rehabilitation (Tyler, Dr. Schmitt, Dr. Bialek, Tran, Dr. Brown), Loyola University Health System, Maywood, IL 60153, United States; the Department of Orthopedic Surgery (Dr. Long), NYU Langone Orthopedic Hospital, New York, NY; and the Insall Scott Kelly Institute for Orthopaedics and Sports Medicine (Dr. Long), New York, NY.
Introduction:
Periprosthetic joint infection (PJI) is a serious complication after total hip arthroplasty (THA). Previous work has explored risk factors of infection, but few studies have evaluated whether surgical approach influences the microbiologic profile of THA PJIs.
Methods:
A retrospective review identified patients who developed PJI after primary THA between January 2007 and January 2024. The surgical approach (direct anterior vs. posterior) was determined from surgical reports. Infecting organisms were categorized as gram-positive, gram-negative, polymicrobial, or culture-negative. Clinical and microbiologic variables were compared between approaches. Among culture-positive, microbiologically homogeneous infections, multivariable logistic regression assessed the association between approach and gram-negative infection.
Results:
Eighty-three patients met inclusion criteria: 22 with anterior and 61 with posterior THAs. No significant differences were observed in age, sex, body mass index, Charlson Comorbidity Index, or SIRS score between cohorts (P > 0.05). Organism profiles were broadly similar across groups, with no statistically significant differences in specific pathogens or microbiologic categories, including gram-positive, gram-negative, or culture-negative PJIs. Although not statistically significant, polymicrobial infections were more common in the posterior cohort (13.1 vs. 4.5%, P = 0.433) and gram-negative organisms in the anterior cohort (18.2 vs. 4.9%, P = 0.076). On multivariable analysis, the surgical approach trend toward gram-negative infections remained but was not statistically significant (OR, 3.79; 95% CI, 0.74 to 19.34; P = 0.110).
Conclusion:
The surgical approach was not associated with significant differences in the infecting organism profile after THA PJI. However, the observed trend toward more gram-negative infections with the anterior approach warrants additional investigation.
Insights
Surgical approach did not significantly alter the types of bacteria causing periprosthetic joint infection (PJI) after total hip arthroplasty (THA). However, a trend suggested more gram-negative infections with the anterior approach, meriting further study.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Microbiology
Background:
- Periprosthetic joint infection (PJI) is a severe complication following total hip arthroplasty (THA).
- Understanding risk factors for THA PJI is crucial, with surgical approach being a potential, understudied factor influencing infection profiles.
Purpose of the Study:
- To investigate the association between surgical approach (direct anterior vs. posterior) and the microbiologic profile of THA PJIs.
- To determine if specific bacterial types are more prevalent based on the surgical technique used during THA.
Main Methods:
- Retrospective review of patients who developed PJI after primary THA between 2007 and 2024.
- Categorization of infecting organisms (gram-positive, gram-negative, polymicrobial, culture-negative) and comparison between anterior and posterior surgical approaches.
- Multivariable logistic regression analysis to assess the link between surgical approach and gram-negative infections in culture-positive, homogeneous cases.
Main Results:
- Eighty-three patients (22 anterior, 61 posterior) were analyzed; no significant demographic or comorbidity differences were found between groups.
- Microbiologic profiles, including pathogen types and categories (gram-positive, gram-negative, culture-negative), showed no statistically significant differences between surgical approaches.
- A non-significant trend indicated polymicrobial infections were more common with the posterior approach and gram-negative infections with the anterior approach (P=0.076).
Conclusions:
- The surgical approach for THA does not appear to significantly influence the overall infecting organism profile in PJI.
- A potential trend towards increased gram-negative infections with the anterior surgical approach warrants further investigation and validation in larger cohorts.
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