Periprosthetic Joint Infection in Patients Who Have Multiple Prostheses in Place

Abstract

Background: Although periprosthetic joint infection (PJI) can affect multiple joints concurrently, the majority of patients with multiple prosthetic joints present with PJI of a single joint. Data regarding the optimal management of these patients are limited. We aimed to identify the prevalence, risk factors for a subsequent PJI, and clinical circumstances of PJI in patients with multiple prosthetic joints. Methods: We retrospectively reviewed the clinical records of 197 patients with ≥2 total joint prostheses in place who presented with PJI from 2000 to 2017. The average follow-up was 3.6 years (range, 0.5 to 17 years). Demographic data and risk factors for synchronous or metachronous PJI were identified. The time from the initial to the second PJI and organism profile data were collected as well. The workup for other joints with a prosthesis in place at the time of the initial PJI was noted. Results: Among the 197 patients with PJI and multiple joint prostheses in situ, 37 (19%) developed PJI in another joint; 11 had a synchronous PJI and 26 had a metachronous PJI. The average time between the first and the second infection in the metachronous cases was 848 days (range, 20 to 3,656 days). Females and patients with an initial PJI with methicillin-resistant Staphylococcus aureus (MRSA) were more likely to have a metachronous PJI, and patients with rheumatoid arthritis had an increased risk of a second (metachronous or synchronous) PJI. Three of 11 patients in the synchronous group and 19% (5) of the 26 in the metachronous group had bacteremia at the time of the initial PJI compared with 12% (19) of the 160 with a single PJI. The percentage of negative cultures increased from 10% for the initial PJIs to 38% for the metachronous PJIs. Conclusions: Patients who have multiple prosthetic joints in place and present with PJI of a single joint are at risk of developing PJI in another joint. Female sex, rheumatoid arthritis, bacteremia at presentation, and infection with MRSA appear to be risk factors for PJI of another joint. Clinical evaluation of the other prosthetic joint(s) should be carried out in all patients and aspiration of those joint(s) should be considered for patients with any of the above risk factors. Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

How to Handle Concomitant Asymptomatic Prosthetic Joints During an Episode of Hematogenous Periprosthetic Joint Infection, a Multicenter Analysis

“…First, we analyzed only patients with a hematogenous PJI who had at least 1 other prosthetic joint in situ. However, it is known that patients with a history of PJI have a higher chance of having a second PJI, especially during an episode of bacteremia [14][15][16]. Thus, even in this "high-risk" group, the chance of having a PJI in an asymptomatic joint at the time of having a hematogenous PJI is very low.…”

“…Timely diagnosis is thus of extreme importance. Patients who are diagnosed with a PJI and who have concomitant prosthetic joints in situ appear to have the highest risk for having a second PJI [14][15][16]. Therefore, we retrospectively analyzed a cohort of patients with hematogenous PJI who also had 1 or more concomitant prosthetic joints in situ at the time of PJI diagnosis.…”

Infecção periprotética do joelho – Parte 1: Fatores de risco, classificação e diagnóstico

“…15,16 Quanto ao gênero, alguns estudos mostram maior taxa de infecção em homens do que em mulheres 15,16 Negros também apresentam maior percentual de infecção quando comparados aos brancos. 21 Komnos et al 32 avaliaram retrospectivamente pacientes com artroplastias em mais de uma articulação. No referido estudo, concluíram que IPP de uma articulação pode predispor à infecção, por via hematogênica, em outro sítio protético.…”

“…15,16 Regarding gender, some studies show a higher infection rate in men than in women 15,16 Afro descendants also have higher percentage of infection when compared with Caucasians. 21 Komnos et al 32 retrospectively evaluated patients with arthroplasties in more than one joint. In this study, they concluded that periprosthetic infection of a joint may predispose to hematogenous infection in another prosthetic site.…”

“…Komnos et al 32 retrospectively evaluated patients with arthroplasties in more than one joint. In this study, they concluded that periprosthetic infection of a joint may predispose to hematogenous infection in another prosthetic site.…”