Predictors of Treatment Success After Periprosthetic Joint Infection: 24-Month Follow up From a Multicenter Prospective Observational Cohort Study of 653 Patients

Abstract

Background Peri-prosthetic joint infection (PJI) is a devastating condition and there is a lack of evidence to guide its management. We hypothesised that treatment success is independently associated with modifiable variables in surgical and antibiotic management. Methods Prospective, observational study at 27 hospitals across Australia and New Zealand. Newly diagnosed large joint PJIs were eligible. Data were collected at baseline and at 3, 12 and 24 months. The main outcome measures at 24 months were clinical cure (defined as all of: alive, absence of clinical or microbiological evidence of infection and not requiring ongoing antibiotic therapy) and treatment success (clinical cure plus index prosthesis still in place). Findings 24-month outcome data were available for 653 patients. Overall, 449 (69%) experienced clinical cure and 350 (54%) treatment success. The most common treatment strategy was debridement and implant retention, with success rates highest in early post-implant infections (119/160; 74%) and lower in late acute (132/267, 49%) and chronic (63/142, 44%) infections. Selected comorbidities, knee joint and S.aureus infections were independently associated with treatment failure, but antibiotic choice and duration (including rifampicin use) and extent of debridement were not. Interpretation Treatment success in PJI is associated with selecting the appropriate treatment strategy, and with non-modifiable patient and infection factors. Interdisciplinary decision-making which matches an individual patient to an appropriate management strategy is a critical step for PJI management. Randomised controlled trials are needed to determine the role of rifampicin in patients managed with DAIR and the optimal surgical strategy for late-acute PJI.

Time to Positivity of Cultures Obtained for Periprosthetic Joint Infection

“…Second, PJI is a complex disease process and therefore no standardized treatment protocol has been defined to date 45 . As such, patients at the same institution may have received different management plans 46 . This may have confounded our analysis and may have reduced the generalizability of our findings.…”

Characteristics and outcomes of culture-negative prosthetic joint infections from the Prosthetic Joint Infection in Australia and New Zealand Observational (PIANO) cohort study

“…Prosthetic joint infection (PJI) is a devastating complication of joint arthroplasty that is associated with significant patient morbidity and economic burden (Del Pozo and Patel, 2009;Moore et al, 2015). PJI complicates 1 %-2 % of primary arthroplasties (Del Pozo and Patel, 2009) and up to 8 % of cases following revision arthroplasty (Quinlan et al, 2020).…”

“…Prosthetic joint infection (PJI) is a devastating complication of joint arthroplasty that is associated with significant patient morbidity and economic burden (Del Pozo and Patel, 2009;Moore et al, 2015). PJI complicates 1 %-2 % of primary arthroplasties (Del Pozo and Patel, 2009) and up to 8 % of cases following revision arthroplasty (Quinlan et al, 2020). Identification of pathogenic organisms from culture of synovial fluid and periprosthetic tissue is a cornerstone of PJI diagnosis and treatment decisions (Parvizi et al, 2018;McNally et al, 2021;Osmon et al, 2013).…”

The Impact of a Dedicated Multidisciplinary Team Approach for Prosthetic Joint Infections of the Lower Limb

“…Multiple factors may have contributed to this, including the varying microbiological profiles and PJI type between each group. Other studies reporting treatment success include Davis et al [ 39 ], who analysed 2-year outcome data of patients with large joint PJI and reported on clinical cure (defined as: alive, absence of clinical or microbiological evidence of infection, and not requiring ongoing antibiotic therapy), and treatment success which was defined as clinical cure (as above) plus index prosthesis still in situ. Based on these definitions, clinical cure rate was 69%, while 54% of patients had treatment success in this study, which appear quite low however this could be contributed to by how they variably defined treatment success.…”