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Updated: Oct 9, 2026
Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
Published on: December 3, 2017
Early Readmission and Mortality Across Periprosthetic Joint Infection Trajectories After Revision Arthroplasty
Wei Yao1, Sijie Chen1, Xuming Chen1
1Department of Orthopaedics and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
Background:
Revision for periprosthetic joint infection (PJI) carries greater morbidity than aseptic revision, but infection history alone does not distinguish patients who remain infection-free from those who develop recurrent PJI. We examined readmission and mortality across an exploratory revision-infection trajectory framework.
Methods:
We retrospectively analyzed 1,228 patients who underwent revision hip or knee arthroplasty between September 30, 2008, and September 1, 2024. Patients were categorized into four trajectory groups according to the indication for index revision and subsequent post-revision PJI status. Outcomes were 90-day unplanned readmission after index revision and all-cause mortality. Because post-revision PJI status was determined during follow-up, 90-day readmission was interpreted descriptively as an early feature of the observed trajectory; mortality was evaluated using Cox proportional hazards models.
Results:
Post-revision PJI occurred in 43 patients (3.5%). The median follow-up was 73.7 months (range, 0.7 to 202.2). Among patients who developed post-revision PJI during follow-up, six of 43 (14.0%) had a 90-day readmission, compared with 54 of 1,185 (4.6%) without post-revision PJI (adjusted odds ratio (OR), 4.39; 95% confidence interval (CI), 1.69 to 11.42; P = 0.002). The highest observed readmission rate was in the trajectory defined by index revision for PJI followed by recurrent PJI (five of 30 [16.7%]). In Cox proportional hazards analyses, post-revision PJI was associated with mortality (adjusted hazard ratio (HR), 3.51; 95% CI, 1.34 to 9.22; P = 0.011); this trajectory also had the highest mortality point estimate (adjusted HR, 5.31; 95% CI, 1.88 to 15.00; P = 0.002).
Conclusions:
Early readmission was more common among patients whose trajectories included post-revision PJI, whereas the trajectory defined by index revision for PJI followed by recurrent PJI had the highest observed mortality. The sequence of revision and infection events may provide more context than infection history alone, but these exploratory associations require external validation.
