Risk Factors for Recurrence of Periprosthetic Joint Infection Following Operative Management: a Cohort Study with Average 5-year Follow-up

Overview

Journal Ann Jt

Publisher AME Publishing Company

Date 2024 Mar 26

PMID 38529229

Authors

Seper Ekhtiari

Aaron Gazendam

Ahmed Saidahmed

Danielle Petruccelli

Mitchell J Winemaker

Justin D de Beer

Vivek Shah

Thomas J Wood

Affiliations

Soon will be listed here.

Abstract

Background: Periprosthetic joint infections (PJIs) remain challenging to eradicate even after surgical management, which in most cases involves either debridement, antibiotics and implant retention (DAIR) or single- or two-staged revision. The purpose of this study is to determine predictors of PJI recurrence after operative management for PJI, and to determine differences in recurrence-free survival between DAIR and staged revision.

Methods: This is a retrospective analysis of prospectively collected data of revision hip and knee arthroplasty surgeries due to PJI between 2011 and 2018 at an academic hospital. Any patient undergoing revision surgery for PJI was included except if the index surgery information was unknown. The primary outcome was confirmed PJI recurrence. Multivariable logistic regression analysis was utilized to determine the relationship between the predictor variables and outcome variable. Log rank testing was used to compare recurrence-free survival between DAIR and staged revision.

Results: A total of 89 patients (91 joints) underwent revision surgery due to PJI. Younger age and presence of a sinus tract were statistically significant for risk of PJI recurrence. A multivariable logistic regression model including both variables was significant for predicting recurrence of PJI (χ=10.2, P=0.006). Survival was not significantly different between patients who underwent DAIR versus a staged revision.

Conclusions: Younger patients and those with a chronic sinus tract are at significantly higher risk of recurrent PJI. This study also demonstrated that PJI can be successfully managed in the majority of cases with DAIR or staged revision.

References

Hsieh P, Lee M, Hsu K, Chang Y, Shih H, Ueng S . Gram-negative prosthetic joint infections: risk factors and outcome of treatment. Clin Infect Dis. 2009; 49(7):1036-43. DOI: 10.1086/605593. View

Mandl L . Determining who should be referred for total hip and knee replacements. Nat Rev Rheumatol. 2013; 9(6):351-7. DOI: 10.1038/nrrheum.2013.27. View

Inoue D, Xu C, Yazdi H, Parvizi J . Age alone is not a risk factor for periprosthetic joint infection. J Hosp Infect. 2019; 103(1):64-68. DOI: 10.1016/j.jhin.2019.04.005. View

Healy W, Della Valle C, Iorio R, Berend K, Cushner F, Dalury D . Complications of total knee arthroplasty: standardized list and definitions of the Knee Society. Clin Orthop Relat Res. 2012; 471(1):215-20. PMC: 3528930. DOI: 10.1007/s11999-012-2489-y. View

Azzam K, Seeley M, Ghanem E, Austin M, Purtill J, Parvizi J . Irrigation and debridement in the management of prosthetic joint infection: traditional indications revisited. J Arthroplasty. 2010; 25(7):1022-7. DOI: 10.1016/j.arth.2010.01.104. View

Kubista B, Hartzler R, Wood C, Osmon D, Hanssen A, Lewallen D . Reinfection after two-stage revision for periprosthetic infection of total knee arthroplasty. Int Orthop. 2011; 36(1):65-71. PMC: 3251662. DOI: 10.1007/s00264-011-1267-x. View

Bursac Z, Gauss C, Williams D, Hosmer D . Purposeful selection of variables in logistic regression. Source Code Biol Med. 2008; 3:17. PMC: 2633005. DOI: 10.1186/1751-0473-3-17. View

Izakovicova P, Borens O, Trampuz A . Periprosthetic joint infection: current concepts and outlook. EFORT Open Rev. 2019; 4(7):482-494. PMC: 6667982. DOI: 10.1302/2058-5241.4.180092. View

Lee Q, Mak W, Wong Y . Risk factors for periprosthetic joint infection in total knee arthroplasty. J Orthop Surg (Hong Kong). 2015; 23(3):282-6. DOI: 10.1177/230949901502300303. View

10.

Xu C, Tan T, Chen J . Positive Culture During Reimplantation Increases the Risk of Reinfection in Two-Stage Exchange Arthroplasty Despite Administrating Prolonged Antibiotics: A Retrospective Cohort Study and Meta-Analysis. J Arthroplasty. 2019; 34(5):1025-1031. DOI: 10.1016/j.arth.2019.01.039. View

11.

Eka A, Chen A . Patient-related medical risk factors for periprosthetic joint infection of the hip and knee. Ann Transl Med. 2015; 3(16):233. PMC: 4598452. DOI: 10.3978/j.issn.2305-5839.2015.09.26. View

12.

Barros L, Barbosa T, Esteves J, Abreu M, Soares D, Sousa R . Early Debridement, antibiotics and implant retention (DAIR) in patients with suspected acute infection after hip or knee arthroplasty - safe, effective and without negative functional impact. J Bone Jt Infect. 2020; 4(6):300-305. PMC: 6960028. DOI: 10.7150/jbji.39168. View

13.

Bumpass D, Nunley R . Assessing the value of a total joint replacement. Curr Rev Musculoskelet Med. 2012; 5(4):274-82. PMC: 3702749. DOI: 10.1007/s12178-012-9139-6. View

14.

Tande A, Gomez-Urena E, Berbari E, Osmon D . Management of Prosthetic Joint Infection. Infect Dis Clin North Am. 2017; 31(2):237-252. DOI: 10.1016/j.idc.2017.01.009. View

15.

Parvizi J, Tan T, Goswami K, Higuera C, Della Valle C, Chen A . The 2018 Definition of Periprosthetic Hip and Knee Infection: An Evidence-Based and Validated Criteria. J Arthroplasty. 2018; 33(5):1309-1314.e2. DOI: 10.1016/j.arth.2018.02.078. View

16.

Zmistowski B, Fedorka C, Sheehan E, Deirmengian G, Austin M, Parvizi J . Prosthetic joint infection caused by gram-negative organisms. J Arthroplasty. 2011; 26(6 Suppl):104-8. DOI: 10.1016/j.arth.2011.03.044. View

17.

Parvizi J, Gehrke T . Definition of periprosthetic joint infection. J Arthroplasty. 2014; 29(7):1331. DOI: 10.1016/j.arth.2014.03.009. View

18.

Kurtz S, Lau E, Schmier J, Ong K, Zhao K, Parvizi J . Infection burden for hip and knee arthroplasty in the United States. J Arthroplasty. 2008; 23(7):984-91. DOI: 10.1016/j.arth.2007.10.017. View

19.

Abbas K, Murtaza G, Umer M, Rashid H, Qadir I . Complications of total hip replacement. J Coll Physicians Surg Pak. 2012; 22(9):575-8. DOI: 09.2012/JCPSP.575578. View

20.

Grammatopoulos G, Kendrick B, McNally M, Athanasou N, Atkins B, McLardy-Smith P . Outcome Following Debridement, Antibiotics, and Implant Retention in Hip Periprosthetic Joint Infection-An 18-Year Experience. J Arthroplasty. 2017; 32(7):2248-2255. DOI: 10.1016/j.arth.2017.02.066. View