Synchronous Periprosthetic Joint Infections: High Mortality, Reinfection, and Reoperation

Elizabeth B. Gausden, Mark W. Pagnano, Kevin I. Perry, Gina A. Suh, Daniel J. Berry, Matthew P. Abdel

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Synchronous periprosthetic joint infections (PJIs) are a catastrophic complication with potentially high mortality. We aimed to report mortality, risk of reinfection, revision, reoperation, and implant survivorship after synchronous PJIs. Methods: We identified 34 patients treated for PJI in more than one joint within a single 90-day period from 1990 to 2018. PJIs involved bilateral knee arthroplasty (27), bilateral hip arthroplasty (4), 1 knee arthroplasty and 1 elbow arthroplasty (1), 1 knee arthroplasty and 1 shoulder arthroplasty (1), and bilateral hip and knee arthroplasty (1). Irrigation and debridement with component retention was performed in 23 patients, implant resection in 10 patients, and a combination of irrigation and debridement with component retention and implant resection in 1 patient. A competing risk model was used to analyze implant survivorship, and Kaplan-Meier survival was used for patient mortality. Mean follow-up was 6 years. Results: Mortality was high at 18% at 30 days and 27% at 1 year. The 1-year cumulative incidence of any reinfection was 13% and 27% at 5 years. The 1-year cumulative incidence of any revision or implant removal was 6% and 20% at 5 years. The 1-year cumulative incidence of unplanned reoperation was 25% and 35% at 5 years. Rheumatoid arthritis was associated with increased risk of mortality (HR 7, P <.01), as was liver disease (HR 4, P =.02). Conclusion: In the largest series to date, patients with synchronous PJIs had a high 30-day mortality rate of 18%, and one-fourth underwent unplanned reoperation within the first year.

Original languageEnglish (US)
JournalJournal of Arthroplasty
DOIs
StateAccepted/In press - 2021

Keywords

  • metachronous PJI
  • revision THA
  • revision TKA
  • septic revision
  • total hip arthroplasty (THA)
  • total knee arthroplasty (TKA)

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

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