The Influence of Patient Sex on Outcomes Following One-Stage and Two-Stage Revision for Periprosthetic Joint Infection in Total Joint Arthroplasty

Overview

Journal Antibiotics (Basel)

Specialty Pharmacology

Date 2023 Sep 28

PMID 37760688

Authors

Rory W Metcalf

Taylor Rowe

Megan Tersteeg

Malcolm E Dombrowski

Susan Odum

Jesse E Otero

Affiliations

Soon will be listed here.

Abstract

Although females have a higher rate of primary total joint arthroplasty (TJA), males have a higher rate of revision. The literature lacks studies examining the relationship between sex and outcomes following single and two-stage exchange for periprosthetic joint infection (PJI). The purpose of this study was to examine if differences exist in outcomes following revision for chronic PJI between sexes. A retrospective review was performed on all patients with an MSIS confirmed PJI who underwent a single or two-stage exchange at our institution from January 2010 to January 2021. Patient demographics, comorbidity characteristics, and outcomes were collected and compared between males and females. The primary outcome variable was disease-free survival at 1 year following definitive revision. Multivariable logistic regression analysis was performed to determine risk factors for failure. Of the 470 patients meeting final eligibility criteria, 250 were male and 226 were female (2 males and 4 females had a joint infection of either the contralateral side or a different joint and were treated as separate records). Of the patients in the cohort, 80% of the males (200/250) and 80% of the females (181/226) were found to be disease-free at 1-year follow-up ( > 0.99). Multivariable logistic regression analysis showed that nicotine use and diabetes, but not sex, were significant predictors of failure. Our study did not find a relationship between sex and outcome of revision for PJI. Further research is required to determine whether differences exist between males and females in the expression of PJI and outcomes following treatment.

Citing Articles

Incidence of periprosthetic joint infection after primary total knee arthroplasty shows significant variation : a synthesis of meta-analysis and bibliometric analysis.

Ma T, Jiao J, Guo D, Lv S, Zhang D, Hou D J Orthop Surg Res. 2024; 19(1):649.

PMID: 39396015 PMC: 11470562. DOI: 10.1186/s13018-024-05099-8.

Phase 1 study of the pharmacokinetics and clinical proof-of-concept activity of a biofilm-disrupting human monoclonal antibody in patients with chronic prosthetic joint infection of the knee or hip.

Conway J, Delanois R, Mont M, Stavrakis A, McPherson E, Stolarski E Antimicrob Agents Chemother. 2024; 68(8):e0065524.

PMID: 39012102 PMC: 11304715. DOI: 10.1128/aac.00655-24.

Differences in the Synovial Fluid Proteome of Septic and Aseptic Implant Failure.

Sowislok A, Busch A, Kaschani F, Kaiser M, Jager M Antibiotics (Basel). 2024; 13(4).

PMID: 38667022 PMC: 11047638. DOI: 10.3390/antibiotics13040346.

Microvascular free flap coverage of complex soft tissue defects after revision total knee arthroplasty: a cross-sectional observation study.

Hamrouni N, Hojvig J, Knudsen U, Skovgaard K, Jensen L, Bonde C Acta Orthop. 2024; 95:186-191.

PMID: 38630868 PMC: 11024721. DOI: 10.2340/17453674.2024.40183.

References

Fillingham Y, Della Valle C, Suleiman L, Springer B, Gehrke T, Bini S . Definition of Successful Infection Management and Guidelines for Reporting of Outcomes After Surgical Treatment of Periprosthetic Joint Infection: From the Workgroup of the Musculoskeletal Infection Society (MSIS). J Bone Joint Surg Am. 2019; 101(14):e69. DOI: 10.2106/JBJS.19.00062. View

Flores-Mireles A, Walker J, Caparon M, Hultgren S . Urinary tract infections: epidemiology, mechanisms of infection and treatment options. Nat Rev Microbiol. 2015; 13(5):269-84. PMC: 4457377. DOI: 10.1038/nrmicro3432. View

Bozic K, Wagie A, Naessens J, Berry D, Rubash H . Predictors of discharge to an inpatient extended care facility after total hip or knee arthroplasty. J Arthroplasty. 2006; 21(6 Suppl 2):151-6. DOI: 10.1016/j.arth.2006.04.015. View

Cancienne J, Werner B, Bolarinwa S, Browne J . Removal of an Infected Total Hip Arthroplasty: Risk Factors for Repeat Debridement, Long-term Spacer Retention, and Mortality. J Arthroplasty. 2017; 32(8):2519-2522. DOI: 10.1016/j.arth.2017.03.018. View

Parvizi J, Adeli B, Zmistowski B, Restrepo C, Greenwald A . Management of periprosthetic joint infection: the current knowledge: AAOS exhibit selection. J Bone Joint Surg Am. 2012; 94(14):e104. DOI: 10.2106/JBJS.K.01417. View

McPherson E, Woodson C, Holtom P, Roidis N, Shufelt C, Patzakis M . Periprosthetic total hip infection: outcomes using a staging system. Clin Orthop Relat Res. 2002; (403):8-15. View

Novicoff W, Saleh K . Examining sex and gender disparities in total joint arthroplasty. Clin Orthop Relat Res. 2011; 469(7):1824-8. PMC: 3111779. DOI: 10.1007/s11999-010-1765-y. View

Capozzi J, Lepkowsky E, Callari M, Jordan E, Koenig J, Sirounian G . The Prevalence of Diabetes Mellitus and Routine Hemoglobin A1c Screening in Elective Total Joint Arthroplasty Patients. J Arthroplasty. 2016; 32(1):304-308. DOI: 10.1016/j.arth.2016.06.025. View

Kong L, Cao J, Zhang Y, Ding W, Shen Y . Risk factors for periprosthetic joint infection following primary total hip or knee arthroplasty: a meta-analysis. Int Wound J. 2016; 14(3):529-536. PMC: 7949746. DOI: 10.1111/iwj.12640. View

10.

Friedman R, Hess S, Berkowitz S, Homering M . Complication rates after hip or knee arthroplasty in morbidly obese patients. Clin Orthop Relat Res. 2013; 471(10):3358-66. PMC: 3773108. DOI: 10.1007/s11999-013-3049-9. View

11.

Karlson E, Daltroy L, Liang M, Eaton H, Katz J . Gender differences in patient preferences may underlie differential utilization of elective surgery. Am J Med. 1997; 102(6):524-30. DOI: 10.1016/s0002-9343(97)00050-8. View

12.

Katz J, Wright E, Guadagnoli E, Liang M, Karlson E, Cleary P . Differences between men and women undergoing major orthopedic surgery for degenerative arthritis. Arthritis Rheum. 1994; 37(5):687-94. DOI: 10.1002/art.1780370512. View

13.

Ritter M, Wing J, Berend M, Davis K, Meding J . The clinical effect of gender on outcome of total knee arthroplasty. J Arthroplasty. 2008; 23(3):331-6. DOI: 10.1016/j.arth.2007.10.031. View

14.

Kapadia B, Berg R, Daley J, Fritz J, Bhave A, Mont M . Periprosthetic joint infection. Lancet. 2015; 387(10016):386-394. DOI: 10.1016/S0140-6736(14)61798-0. View

15.

Lu Y, Zhou Z, Liu Y, Chen H, Yang H, Liu F . Gender differences of venous thromboembolism risk after total hip and total knee arthroplasty: a meta-analysis. J Thromb Thrombolysis. 2015; 41(4):556-62. DOI: 10.1007/s11239-015-1283-6. View

16.

Sloan M, Premkumar A, Sheth N . Projected Volume of Primary Total Joint Arthroplasty in the U.S., 2014 to 2030. J Bone Joint Surg Am. 2018; 100(17):1455-1460. DOI: 10.2106/JBJS.17.01617. View

17.

Brown T, Fehring K, Ollivier M, Mabry T, Hanssen A, Abdel M . Repeat two-stage exchange arthroplasty for prosthetic hip re-infection. Bone Joint J. 2018; 100-B(9):1157-1161. DOI: 10.1302/0301-620X.100B9.BJJ-2018-0470.R1. View

18.

Petis S, Abdel M, Perry K, Mabry T, Hanssen A, Berry D . Long-Term Results of a 2-Stage Exchange Protocol for Periprosthetic Joint Infection Following Total Hip Arthroplasty in 164 Hips. J Bone Joint Surg Am. 2019; 101(1):74-84. DOI: 10.2106/JBJS.17.01103. View

19.

Ong K, Lau E, Manley M, Kurtz S . Patient, hospital, and procedure characteristics influencing total hip and knee arthroplasty procedure duration. J Arthroplasty. 2008; 24(6):925-31. DOI: 10.1016/j.arth.2008.07.002. View

20.

Bohl D, Sershon R, Fillingham Y, Della Valle C . Incidence, Risk Factors, and Sources of Sepsis Following Total Joint Arthroplasty. J Arthroplasty. 2016; 31(12):2875-2879.e2. DOI: 10.1016/j.arth.2016.05.031. View