Abstract

The rate for periprosthetic joint infection (PJI) exceeds 1% for primary arthroplasties. Over 30% of patients who have a primary arthroplasty require additional arthroplasties, and the impact of PJI on this population is understudied. Our objective was to assess the prevalence of recurrent, synchronous, and metachronous PJI in patients who had multiple arthroplasties and to identify risk factor profiles.We identified 337 patients who had multiple arthroplasties and at least one PJI that presented between 2003 and 2021. The mean follow-up after revision arthroplasty was 3 years (range, 0 to 17.2). Patients who had multiple infected prostheses were categorized as synchronous (i.e., presenting at the same time as the initial infection) or metachronous (i.e., presenting at a different time as the initial infection). The PJI diagnosis was made using the MusculoSkeletal Infection Society (MSIS) criteria.There were 39 (12%) patients who experienced recurrent PJI, while 31 (9%) patients developed PJI in a second joint. Positive blood cultures were more likely in second joint PJI (48%) compared to recurrent PJI (23%) or single PJI (15%, P<0.001). Synchronous PJI represented 42% of second joint PJI cases (n=13), while metachronous PJI represented 58% (n=18). Tobacco users had 75% higher odds of metachronous PJI (Odds Ratio 1.75, 95% Confidence Interval: 1.1-2.9, P=0.041).Over 20% of the patients who have multiple arthroplasties and a PJI will develop a subsequent PJI in another arthroplasty - 12% will occur in the initial arthroplasty and nearly 10% will occur in another arthroplasty. Particular caution should be taken in patients who use tobacco and had bacteremia or Staphylococcus aureus isolation at time of initial PJI. Optimizing the management of this high-risk patient population is necessary to reduce the additional burden of subsequent PJI.

View details for DOI 10.1016/j.arth.2023.03.014

View details for PubMedID 36924855