Sex-Specific Differences in Microbiological Patterns and Outcomes in Periprosthetic Joint Infection

The impact of sex-specific aspects on patients suffering from periprosthetic joint infections (PJIs) is widely unknown. In this retrospective study, microbiology and outcome were compared between men and women suffering from PJI, aiming at offering a sex-specific perspective of this entity.

Patients who were treated for PJI between 2015 and 2020 were retrospectively evaluated and allocated in two groups according to their biological sex. Periprosthetic joint infection was defined according to European Bone and Joint Infection Society criteria. Variables were compared using Fisher exact tests or Mann-Whitney U tests, where appropriate. Infection-free survival was determined by Kaplan-Meier analysis and compared between groups using the log-rank test.

Of 294 included PJI episodes, 178 (60.5%) were experienced by men and 116 (39.5%) by women. The infections affected 171 hips and 123 knees, with similar distribution in both sexes. Monomicrobial infection was diagnosed in 253 episodes (86.0%), with a dominance of staphylococci in both groups; 28 (10.0%) were polymicrobial and 13 (4.4%) culture-negative with the same distribution in both groups. Women had more PJI caused by Gram-negative rods (GNRs) than men (18.8 versus 5.9%, P = 0.002). Applied surgical strategies were similar in both groups. The median duration of antimicrobial treatment was longer in men than in women (13.5 versus 12.5 weeks, P = 0.010). After a median follow-up time of 23.58 (range, 0.23 to 75.97) months, 44 of 174 (25.3%) men and 30 of 112 (26.8%) women had an infection failure. The failure rate in women who had a PJI caused by GNRs was higher than in men.

Overall, treatment outcome was similar in both sexes, except in patients suffering from PJI caused by GNRs, where a higher failure rate was observed in women compared to men.