Patient-related Risk Factors for Postoperative Mortality and Periprosthetic Joint Infection in Medicare Patients Undergoing TKA

Abstract Background: The incidence of superficial surgical site infection (SSSI) may increase the risk of subsequent periprosthetic joint infection (PJI). Optimisation or even avoiding patient-related risk factors for SSSI preoperatively, may decrease the risk of subsequent PJI. Purpose: To identify patient-related risk factors associated with SSSI and investigate their correlation with the progression of PJI. Methods: 1,291 primary elective hip and knee prosthesis were included. Patients were personally contacted by a nurse ≥ 3 month after surgery to answer questions about the postoperative period, including any occurrences of SSSI. The diagnosed PJI was determined by an orthopaedic surgeon together with a specialist in infectious diseases, and all patients with PJI underwent revision surgery. The patient-related risk factors considered relevant were joint, age, sex, American Society of Anesthesiologists classification (ASA), body mass index (BMI), smoking, diabetes and rheumatological disease. Results: 7,0 % of included patients developed an SSSI, and 1,9 % a PJI. Factors with a significantly increased adjusted risk ratio for SSSI were; knee surgery 1,9 (95% CI: 1,2 – 3,1), age ≥ 65 years 1,7 (95% CI: 1,1 – 2,8), BMI ≥35 2,3 (95% CI: 1,2 – 4,2) and for PJI; knee surgery 2,6 (95% CI: 1,1 – 6,4), ASA-class ≥ 3 3,2 (95% CI: 1,3 – 7,9), BMI ≥35 3,0 (95% CI: (1,2 – 4,2) and male gender 3,0 (95% CI: (1,2 – 7,5). Male patients showed a significant risk of developing PJI following SSSI, with a risk ratio of 3,3 (95% CI: 1,1 – 10,5).Conclusions: Male patients planned for total knee prostheses (TKA) aged 65 or over, with high ASA-class and high BMI should be selected with care due to the increased risk of postoperative infection.

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Risk Factor Analysis for Above-knee Amputation in Patients With Periprosthetic Joint Infection of the Knee: a Case-control Study

10.21203/rs.3.rs-440521/v1 ◽

2021 ◽

Author(s):

Franziska Eckers ◽

Christoph J. Laux ◽

Sebastian Schaller ◽

Martin Berli ◽

Yvonne Achermann ◽

...

Keyword(s):

Risk Factors ◽

Alcohol Abuse ◽

Periprosthetic Joint Infection ◽

Case Control Study ◽

Joint Infection ◽

Case Control ◽

Individual Risk ◽

Preoperative Anemia ◽

Knee Amputation ◽

Control Study

Abstract Background: Periprosthetic joint infection (PJI) is a severe complication following knee arthroplasty. Therapeutic strategies comprise a combination of surgical and antibiotic treatment modalities and aim to eradicate the infection. Sometimes control of the disease can only be attained by above-knee amputation (AKA). While a vast amount of literature exists illuminating predisposing factors for PJI, risk factors favoring the endpoint AKA in this context are sparsely known. Methods: The purpose of this investigation was to delineate whether patients with PJI of the knee present specific risk factors for AKA. In a retrospective case-control study 11 cases of PJI treated with AKA were juxtaposed to 57 cases treated with limb salvage (LS). The minimum follow-up was two years. Comorbidities, signs and symptoms of the current infection, factors related to previous surgeries and the implant, microbiology, as well as therapy related factors were recorded. Comparative analysis was performed using student’s t-test, chi-square test or Fisher’s exact test. Binary differences were calculated using odds ratio (OR). Reoperation frequency was compared using Mann-Whitney U test. In-depth descriptive analysis of 11 amputees was carried out. Results: A total of 68 cases aged 71±11.2 years were examined, hereof 11 with AKA and 57 with LS. Severe comorbidities (p=0.009), alcohol abuse (p=0.015), and preoperative anemia (p=0.022) were more frequently associated with AKA. Preoperative anemia was found in all 11 amputees (100%) and in 33 of 57 LS patients (58%) with an average preoperative hemoglobin of 99.9±15.1 g/dl compared to 118.2±19.9 g/dl (p=0.011). No other parameters differed significantly. AKA patients underwent a median of eight (range 2-24) reoperations, LS patients a median of five (range 2-15).Conclusion: Factors potentially influencing the outcome of knee PJI are diverse. The indication of AKA in this context remains a rarity and a case-by-case decision. Patient-intrinsic systemic factors such as alcohol abuse, severe comorbidities and preoperative anemia may elevate the individual risk for AKA in the setting of PJI. We recommend that anemia, being a condition well amenable to therapeutic measures, should be given special consideration in management of PJI patients. Trial registration: This study was registered with Kantonale Ethikkommission Zürich, (BASEC-No. 2016-01048).

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Meta-analysis in periprosthetic joint infection: a global bibliometric analysis

10.21203/rs.3.rs-18525/v1 ◽

2020 ◽

Author(s):

Cheng Li ◽

Cristina Ojeda Thies ◽

Chi Xu ◽

Andrej Trampuz

Keyword(s):

Risk Factors ◽

Bibliometric Analysis ◽

Periprosthetic Joint Infection ◽

Clinical Medicine ◽

Meta Analysis ◽

Joint Infection ◽

Relevant Literature ◽

The United States ◽

Steroid Injections ◽

Joint Replacement Surgery

Abstract Background: Periprosthetic joint infection (PJI) is the most serious complication of joint replacement surgery. Further comorbidities include bedsore, deep vein thrombosis, reinfection, or even death. An increasing number of researchers are focusing on this challenging complication. The aim of the present study was to estimate global PJI research based on bibliometrics from meta-analysis studies. Methods: A database search was performed in PubMed, Scopus, and Web of Science. Relevant studies were assessed using the bibliometric analysis. Results: A total of 117 articles were included. The most relevant literature on PJI was found on Scopus. China made the highest contributions to global research, followed by the United States and the United Kingdom. The institution with the most contributions from the University of Bristol. The journal with the highest number of publications was The Journal of Arthroplasty, whereas the Journal of Clinical Medicine had the shortest acceptance time. The day of the week with the greatest number of received and accepted manuscripts was Wednesday. Furthermore, the top three frequently used databases were Embase, MEDLINE, and Cochrane. The most frequent number of authors in meta-analysis studies was four. Most studies focused on the periprosthetic hip and knee. The alpha-defensin diagnostic test, preventive measures on antibiotics use, and risk factors of intra-articular steroid injections were the most popular topic in recent years. Conclusion: Based on the results of the present study, we found that there was no single database covered all relevant articles, the optimal method for bibliometric analysis is a combination of databases. The most popular research topics on PJI focused on alpha-defensin, antibiotic use, risk factors of intra-articular steroid injections, and the location of prosthetic hip and knee infection. Alpha-defensin appears to be a reliable tool for the diagnosis of PJI.

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Patients’ risk factors for periprosthetic joint infection in primary total hip arthroplasty: a meta-analysis of 40 studies

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04647-1 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Xiaolei Ren ◽

Lin Ling ◽

Lin Qi ◽

Zhongyue Liu ◽

Wenchao Zhang ◽

...

Keyword(s):

Risk Factors ◽

Femoral Neck ◽

Femoral Neck Fracture ◽

Meta Analysis ◽

Joint Infection ◽

Female Gender ◽

Opioid Use ◽

Related Risk ◽

Modifiable Factors ◽

Neck Fracture

Abstract Background Periprosthetic joint infection (PJI) is a catastrophic complication after total hip arthroplasty (THA). Our meta-analysis aimed to identify the individual-related risk factors that predispose patients to PJI following primary THA. Methods Comprehensive literature retrieval from Pubmed, Web of Science, and the Cochrane Library was performed from inception to Feb 20th, 2021. Patient-related risk factors were compared as per the modifiable factors (BMI, smoke and alcohol abuse), non-modifiable factors (gender, age), and medical history characteristics, such as diabetes mellitus (DM), avascular necrosis (AVN) of femoral head, femoral neck fracture, rheumatoid arthritis (RA), cardiovascular disease (CVD), and osteoarthritis (OA) etc. The meta-analysis was applied by using risk ratios with 95% corresponding intervals. Sensitivity analysis and publication bias were performed to further assess the credibility of the results. Results Overall, 40 studies with 3,561,446 hips were enrolled in our study. By implementing cumulative meta-analysis, higher BMI was found associated with markedly increased PJI risk after primary THA [2.40 (2.01–2.85)]. Meanwhile, medical characteristics including DM [1.64 (1.25–2.21)], AVN [1.65 (1.07–2.56)], femoral neck fracture [1.75 (1.39–2.20)], RA [1.37 (1.23–1.54)], CVD [1.34 (1.03–1.74)], chronic pulmonary disease (CPD) [1.22 (1.08–1.37)], neurological disease [1.19 (1.05–1.35)], opioid use [1.53 (1.35–1.73)] and iron-deficiency anemia (IDA) [1.15 (1.13–1.17)] were also significantly correlated with higher rate of PJI. Conversely, dysplasia or dislocation [0.65 (0.45–0.93)], and OA [0.70 (0.62–0.79)] were protective factors. Of Note, female gender was protective for PJI only after longer follow-up. Besides, age, smoking, alcohol abuse, previous joint surgery, renal disease, hypertension, cancer, steroid use and liver disease were not closely related with PJI risk. Conclusion Our finding suggested that the individual-related risk factors for PJI after primary THA included high BMI, DM, AVN, femoral neck fracture, RA, CVD, CPD, neurological disease, opioid use and IDA, while protective factors were female gender, dysplasia/ dislocation and OA.

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