Risk factors associated with revision for prosthetic joint infection after hip replacement: a prospective observational cohort study

Abstract

SummaryBackgroundThe risk of prosthetic joint infection (PJI) is influenced by patient, surgical, and health-care factors. Existing evidence is based on short-term follow-up. It does not differentiate between factors associated with early onset caused by the primary intervention from those associated with later onset more likely to result from haematogenous spread. We aimed to assess the overall and time-specific associations of these factors with the risk of revision due to PJI after primary total hip replacement.MethodsWe did a prospective observational cohort study analysing 623 253 primary hip procedures performed between April 1, 2003, and Dec 31, 2013, in England and Wales and recorded the number of procedures revised because of PJI. We investigated the associations between risk factors and risk of revision for PJI across the overall follow-up period using Poisson multilevel models. We reinvestigated the associations by post-operative time periods (0–3 months, 3–6 months, 6–12 months, 12–24 months, >24 months) using piece-wise exponential multilevel models with period-specific effects. Data were obtained from the National Joint Registry linked to the Hospital Episode Statistics data.Findings2705 primary procedures were subsequently revised for an indication of PJI between 2003 and 2014, after a median (IQR) follow up of 4·6 years (2·6–7·0). Among the factors associated with an increased revision due to PJI there were male sex (1462 [1·2‰] of 1 237 170 male-years vs 1243 [0·7‰] of 1 849 691 female-years; rate ratio [RR] 1·7 [95% CI 1·6–1·8]), younger age (739 [1·1‰] of 688 000 person-years <60 years vs 242 [0·6‰] of 387 049 person-years ≥80 years; 0·7 [0·6–0·8]), elevated body-mass index (BMI; 941 [1·8‰] 517 278 person-years with a BMI ≥30 kg/m2vs 272 [0·9‰] of 297 686 person-years with a BMI <25 kg/m2; 1·9 [1·7–2·2]), diabetes (245 [1·4‰] 178 381 person-years with diabetes vs 2120 [1·0‰] of 2 209 507 person-years without diabetes; 1·4 [1·2–1·5]), dementia (5 [10·1‰] of 497 person-years with dementia at 3 months vs 311 [2·6‰] of 120 850 person-years without dementia; 3·8 [1·2–7·8]), previous septic arthritis (22 [7·2‰] of 3055 person-years with previous infection vs 2683 [0·9‰] of 3 083 806 person-years without previous infection; 6·7 [4·2–9·8]), fractured neck of femur (66 [1·5‰] of 43 378 person-years operated for a fractured neck of femur vs 2639 [0·9‰] of 3 043 483 person-years without a fractured neck of femur; 1·8 [1·4–2·3]); and use of the lateral surgical approach (1334 [1·0‰] of 1 399 287 person-years for lateral vs 1242 [0·8 ‰] of 1 565 913 person-years for posterior; 1·3 [1·2–1·4]). Use of ceramic rather than metal bearings was associated with a decreased risk of revision for PJI (94 [0·4‰] of 239 512 person-years with ceramic-on-ceramic bearings vs 602 [0·5‰] of 1 114 239 peron-years with metal-on-polyethylene bearings at ≥24 months; RR 0·6 [0·4–0·7]; and 82 [0·4‰] of 190 884 person-years with ceramic-on-polyethyene bearings vs metal-on-polyethylene bearings at ≥24 months; 0·7 [0·5–0·9]). Most of...

Patients' risk factors for periprosthetic joint infection in total hip arthroplasty: A systematic review and meta-analysis of 34 studies

“…Sensitivity analysis was perfo rmed to assess whether the pooled results were credib le. In BM I comparison, sensitivity analysis illustrated that excluding the study by Lenguerrand et al [26] changed the original results and the modified pooled RR (95%CI) was 2.44 ( 2.07-2.86) after excluding this study ( Figure 6A). Ho wever, the significance of BMI in predicting PJI risk was not altered, indicating that high BMI was still positively correlated with increased PJI risk.…”

“…In general, o lder patients are more prone to postoperative infection caused by less competent immunity [5], malnutrit ion status [30] and co mplex medical co mo rbidit ies [8]. On the contrary, a mu lt i-center analysis of 623,253 joint replacements claimed that younger age was closely correlated with elevate d PJI [26], wh ich may be attributed to active use cycles of imp lants, higher possibility of infect ion and revision surgery [30].…”

Treatment of Periprosthetic Infection: Where and Who?

“…При эндопротезировании тазобедренного сустава свежее проспективное когортное исследование 623 253 операций эндопротезирования к имплант-связанным факторам риска отнесло пары трения металл-металл, керамика-металл и металл-керамика [10].…”

Pseudomonas stutzeri prosthetic joint infection: a therapeutic challenge associated with multiple severe complications

“…Posteriormente precisó drenaje de hematoma articular (2016) y recambio en dos tiempos (2017) por infección de prótesis articular por Staphylococcus aureus resistente a meticilina. Todos ellos son conocidos factores de riesgo para el desarrollo de IPA [2]. Ingresa por un nuevo episodio de infección de prótesis articular.…”