Abstract. The objective of our study was to evaluate the association between acute
periprosthetic joint infection (APJI) and radiographic measurement of soft-tissue thickness in elective total hip replacement surgery. A case-control study was conducted to compare the soft-tissue thickness
radiographic measurement (SRM) at the hip in patients diagnosed with APJI
based on Tsukayama et al. (2003) criteria after total hip replacement with patients
that were not infected, at a single institution from 2013 to 2019. To
minimize selection bias, each case was matched with two controls using the
following methodology: patients of the same sex, with an age variation of
± 5 years, and nearest in surgery date to the cases were selected. All
postoperative radiographs were performed in the first 24 h after total hip arthroplasty (THA)
surgery as it is protocolized in our institution. Soft-tissue thickness
radiographic measurement was defined as the distance from the tip of the
greater trochanter to the skin following a perpendicular line to the femoral
diaphysis in postoperative anteroposterior hip radiographs. In total, 78 patients were included (26 cases and 52 controls). The SRM median of the cases
was 76.19 mm (SD: 26.518) and 53.5 mm (SD: 20.47) in controls. A multivariate
logistic regression model showed an independent association between APJI and
SRM (odds ratio (OR) = 1.033, 95 % confidence interval (CI) 1.007–1.059, p=0.012). Patients with an SRM
greater than 60 mm had a 7-fold increase in the odds of APJI
(OR = 7.295, 95 % CI = 2.364–22.511, p<0.001). The results of our study suggest an association between large SRM at the hip
and the risk of APJI in patients with primary total hip arthroplasty. SRM
may be a helpful and easy tool for evaluating the risk of APJI before
elective primary total hip replacement surgery.
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