Proceedings of the International Consensus Meeting on Periprosthetic Joint Infection (original) (raw)
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The Journal of Arthroplasty, 2019
Background: Whether prolonged operative time is an independent risk factor for subsequent surgical site infection (SSI) and periprosthetic joint infection (PJI) following total joint arthroplasty (TJA) remains a clinically significant and underexplored issue. The aim of this study was to investigate the association between operative time and the risk of subsequent SSI and PJI in patients undergoing primary TJA. Methods: We retrospectively reviewed 17,342 primary unilateral total knee arthroplasty and total hip arthroplasty performed at a single institution between 2005-2016, with a minimum follow-up of 1 year. A multivariate logistic regression model was conducted to identify the association between operative time and the development of SSI within 90-days and PJI within 1-year. Results: Overall, the incidence of 90-day SSI and 1-year PJI was 1.2% and 0.8%, respectively. Patients with an operative time of >90 minutes had a significantly higher incidence of SSI and PJI (2.1% and 1.4%, respectively) compared to cases lasting between 60-90 mins (1.1% and 0.7%), and those lasting ≤60 minutes (0.9% and 0.7%; p<0.01). In the multivariate model, the risk for infection increased by an odds ratio (OR) of 1.346 (95% confidential interval [CI] 1.114-1.627) for 90-day SSI and 1.253 (95% CI 1.060-1.481) for 1-year PJI for each 20 minute increase in operative time. Conclusion: In patients undergoing primary TJA, each 20-minute increase in operative time was associated with nearly a 25% increased risk of subsequent PJI. We advocate that surgeons pay close attention to this underappreciated risk factor while maintaining safe operative practices, that minimize unnecessary steps and wasted time in the operating room.
Periprosthetic Joint Infection: The Incidence, Timing, and Predisposing Factors
Clinical Orthopaedics and Related Research, 2008
Periprosthetic joint infection is one of the most challenging complications of joint arthroplasty. We identified current risk factors of periprosthetic joint infection after modern joint arthroplasty, and determined the incidence and timing of periprosthetic joint infection. We reviewed prospectively collected data from our database on 9245 patients undergoing primary hip or knee arthroplasty between January 2001 and April 2006. Periprosthetic joint infections developed in 63 patients (0.7%). Sixty-five percent of periprosthetic joint infections developed within the first year of the index arthroplasty. The infecting organism was isolated in 57 of 63 cases (91%). The most common organisms identified were Staphylococcus aureus and Staphylococcus epidermidis. We identified the following independent predictors for periprosthetic joint infection: higher American Society of Anesthesiologists score, morbid obesity, bilateral arthroplasty, knee arthroplasty, allogenic transfusion, postoperative atrial fibrillation, myocardial infarction, urinary tract infection, and longer hospitalization. This study confirmed some previously implicated factors and identified new variables that predispose patients to periprosthetic joint infection. Level of Evidence: Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.
Reducing the risk of infection after total joint arthroplasty: preoperative optimization
Arthroplasty
Total joint arthroplasty (TJA) is one of the most commonly performed procedures in orthopedic surgery, and as the demand for TJA increases over time, the number of concurrent complications such as surgical infection will also increase. There are multiple risk factors that independently increase the risk of surgical site infection (SSI) and periprosthetic joint infection (PJI) after surgery. These modifiable risk factors can be identified in preoperative clinic screening visits that gives physicians the opportunity to provide specific intervention that can decrease patient infection risk. The risk factors that are known to significantly increase the risk of PJI and/or SSI include MSSA/MRSA colonization, rheumatoid arthritis, cardiovascular and renal disease, obesity, diabetes mellitus, hyperglycemia, anemia, malnutrition, tobacco use, alcohol consumption, depression, and anxiety. Patients who present with one or more of these risk factors require intervention with a multidisciplinary approach including patient education, counseling, and follow-up. Preoperative patient optimization for high risk TJA patients can significantly decrease PJI and SSI risk while improving surgical outcomes and patient care.
Clinical orthopaedics and related research, 2015
After the successful treatment of periprosthetic joint infection (PJI), patients may present with degenerative joint disease in another joint with symptoms severe enough to warrant arthroplasty. However, it is not known whether patients with a history of treated PJI at one site will have an increased risk of PJI in the second arthroplasty site. The primary objective of this study is to determine if there is a difference in the risk of developing a PJI after a second total hip arthroplasty (THA) or total knee arthroplasty (TKA) in patients who have had a previous PJI at another anatomic site compared with patients who have had no history of PJI. The secondary objective is to determine other potential risk factors that may predict PJI at the site of the second arthroplasty. A retrospective matched cohort study was performed to identify all patients at four academic institutions successfully treated for PJI who subsequently underwent a second primary THA or TKA (n = 90), constituting o...
Open Forum Infectious Diseases, 2020
Background. Periprosthetic joint infection (PJI) is a devastating complication of joint replacement surgery. Most observational studies of PJI are retrospective or single-center, and reported management approaches and outcomes vary widely. We hypothesized that there would be substantial heterogeneity in PJI management and that most PJIs would present as late acute infections occurring as a consequence of bloodstream infections. Methods. The Prosthetic joint Infection in Australia and New Zealand, Observational (PIANO) study is a prospective study at 27 hospitals. From July 2014 through December 2017, we enrolled all adults with a newly diagnosed PJI of a large joint. We collected data on demographics, microbiology, and surgical and antibiotic management over the first 3 months postpresentation. Results. We enrolled 783 patients (427 knee, 323 hip, 25 shoulder, 6 elbow, and 2 ankle). The mode of presentation was late acute (>30 days postimplantation and <7 days of symptoms; 351, 45%), followed by early (≤30 days postimplantation; 196, 25%) and chronic (>30 days postimplantation with ≥30 days of symptoms; 148, 19%). Debridement, antibiotics, irrigation, and implant retention constituted the commonest initial management approach (565, 72%), but debridement was moderate or less in 142 (25%) and the polyethylene liner was not exchanged in 104 (23%). Conclusions. In contrast to most studies, late acute infection was the most common mode of presentation, likely reflecting hematogenous seeding. Management was heterogeneous, reflecting the poor evidence base and the need for randomized controlled trials. Keywords. arthroplasty infection; artificial joint infection; periprosthetic jo int infection. Periprosthetic joint infection (PJI) is a devastating complication of joint arthroplasty, resulting in pain, suffering, impaired mobility, prolonged hospitalization, broad-spectrum antibiotic therapy, and societal and economic costs [1-3]. Although arthroplasty revision operations performed for infection have progressively increased [4], estimates from arthroplasty registry data or infection control surveillance may underestimate the true incidence of PJI [5, 6]. Unlike early postoperative or chronic low-grade infections, these data sources do not reliably capture late acute PJI (LA-PJI), which may not be
Periprosthetic infections after total hip and knee arthroplasty--a review
Collegium antropologicum, 2014
Periprosthetic joint infections (PJI) in orthopedic surgery are considered to be very serious and dangerous complications of total joint arthroplasty. PJI becomes a long-lasting medical problem and a heavy burden on patient and his family. Patients with such a complication are a significant financial burden for the health care system. Recognizing this issue, investing in scientific research and simultaneously developing technologies in medicine are efforts taken to increase successfulness in preventing and treating PJI. Each year the number of total joint arthroplasties increases which entails a rise in the number of complications among which infections are the leading ones. Sometimes, in the worst case scenarios, infections can endanger patients' lives. New procedural algorithms and new diagnostic possibilities help us make accurate and early diagnoses of postoperative PJI with a great degree of certainty. These diagnostic methods include laboratory tests, imaging, histopatholo...
Annals of Medicine and Surgery, 2019
Introduction: Arthroplasty has always been associated with complications, such as the possibility of periprosthetic infection. The presence of an active infection at the site of the planned surgery is considered a contraindication for the new implant. However, it is unclear whether there is an association between the presence of remote musculoskeletal infection and the development of infection in the prosthetic joint itself. We report six cases involving patients with active ongoing musculoskeletal infections at a remote site who underwent arthroplasty. Presentation of cases: Four male and two female patients were included in this review. Three patients underwent total hip arthroplasty, one underwent hip hemiarthroplasty, and two underwent total knee arthroplasty. All surgeries were performed in the presence of different stages of infection at a remote site; two had active infections with pus-discharging sinus, one was being treated with long-term oral antibiotic suppression, and three patients were diagnosed with remote prosthetic joint infections on the basis of joint aspiration or intraoperative cultures. Clinical assessments of pain, wound erythema or drainage, and soft tissue swelling were performed at follow-up. Radiography and analysis of inflammatory marker levels were performed preoperatively and 6 weeks postoperatively. Discussion: All six patients were followed-up for at least 18 months (mean, 4.6 years; range, 18 months to 9 years). No evidence of superficial surgical-site infection or deep prosthetic joint infection was observed. Conclusion: The presence of an active infection at a remote site might not be a contributing factor to periprosthetic joint infection.