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Acute Periprosthetic Joint Infection After Primary Total Knee Arthroplasty: Experience From a Secondary Public
Diego Emmanuel Almeida-Muñoz1, Alexis Valenzuela-González2, Ruben Cuevas-Martínez1
1Research, Hospital General Dr Salvador Zubirán Anchondo, Chihuahua, MEX.
Abstract:
Background Periprosthetic joint infection (PJI) is an uncommon but serious complication of total knee arthroplasty (TKA), and local data from secondary-level public hospitals in Mexico are limited. We measured the incidence of acute PJI after primary TKA at our hospital, described the patients who developed it, and established a local baseline for prevention and surveillance. Methods We retrospectively reviewed the medical records of 104 consecutive knee arthroplasty patients from October 2024 to September 2025. After excluding one revision and one bilateral procedure, 102 primary unilateral TKAs performed for osteoarthritis were analyzed. Acute PJI was defined by the Musculoskeletal Infection Society (MSIS)/2018 International Consensus Meeting and Infectious Diseases Society of America (IDSA) criteria. Cohort characteristics and the incidence of acute PJI (with a 95% confidence interval (CI)) were summarized descriptively. With only two events, we did not attempt inferential risk-factor analysis; instead, we describe both cases in detail. Results Two patients developed acute PJI, an incidence of 2.0% (2/102; 95% CI: 0.5-6.9%). The cohort was 56.9% female, with diabetes in 24.5%, hypertension in 44.1%, smokers in 5.9%, preoperative anemia in 13.7%, and no perioperative transfusions. One case was culture-negative with a sinus tract communicating with the joint (a major criterion); the other grew Staphylococcus aureus. Both patients had normal preoperative hemoglobin, required infection-related readmissions (7 and 29 days), and had infections that resolved after debridement, targeted antibiotics, and implant retention, with cultures turning negative and clinical signs resolving by one month and six weeks, respectively, and no recurrence over 12 months of follow-up. Conclusions This study establishes our hospital's first institutional baseline for acute knee PJI after primary TKA. With only two events, the estimate is imprecise (95% CI: 0.5-6.9%) and precludes risk-factor inference, but it supports a guideline-based prevention and surveillance algorithm, a prospective registry, and future adequately powered multicenter studies.
Insights
This study reports a 2.0% incidence of acute periprosthetic joint infection (PJI) after total knee arthroplasty (TKA) in a Mexican hospital. It establishes a local baseline for PJI prevention and surveillance, highlighting the need for further research.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Public Health
Background:
- Periprosthetic joint infection (PJI) is a significant complication following total knee arthroplasty (TKA).
- Limited local data exists for PJI incidence in secondary-level public hospitals in Mexico.
- Establishing a baseline is crucial for improving prevention and surveillance strategies.
Purpose of the Study:
- To measure the incidence of acute PJI after primary TKA at a specific Mexican hospital.
- To describe the characteristics of patients who developed acute PJI.
- To establish a local baseline for PJI prevention and surveillance.
Main Methods:
- Retrospective review of 102 primary unilateral TKA cases performed for osteoarthritis.
- Acute PJI defined by MSIS/2018 ICM and IDSA criteria.
- Descriptive summary of cohort characteristics and PJI incidence; detailed case descriptions for two events.
Main Results:
- An incidence of 2.0% (95% CI: 0.5-6.9%) for acute PJI was observed (2 out of 102 patients).
- The cohort comprised 56.9% females; common comorbidities included diabetes (24.5%) and hypertension (44.1%).
- Both PJI cases resolved with debridement, antibiotics, and implant retention, showing no recurrence within 12 months.
Conclusions:
- This study provides the first institutional baseline for acute knee PJI post-TKA in the analyzed setting.
- The low event count yields an imprecise incidence estimate, precluding risk factor inference.
- Findings support implementing guideline-based prevention, surveillance, a prospective registry, and larger multicenter studies.
