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SSI diagnosed faster after hip vs. knee arthroplasty
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The postoperative diagnosis of invasive surgical site infection following knee arthroplasty is delayed compared with the diagnosis of infection after hip arthroplasty, according to a recent study.
“The timing of the onset of infection in relation to the original arthroplasty is an important criterion used to direct subsequent surgical and medical management of prosthetic infections,” researchers wrote in Clinical Infectious Diseases.
In a retrospective cohort study, the researchers examined surveillance data from the Duke Infection Control Network (DICON), a consortium of community acute care hospitals located in North Carolina, South Carolina, Virginia, Florida and Georgia. The data were from hip and knee arthroplasty procedures performed between Jan. 1, 2007 and Dec. 31, 2011 at facilities within the network.
The analysis was undertaken in two parts: a time-to-event analysis using surgical site infection (SSI) data from DICON, and a descriptive analysis of SSI cases from a subset of patients to determine predictive factors not identified during routine monitoring.
The researchers found that of the 661 SSIs diagnosed, 61% were subsequent to knee arthroplasties. For hip arthroplasties, there was a median time to SSI diagnosis of 25 days (interquartile range, 17-48 days), while the median time to diagnosis of SSI was 42 days (interquartile range, 21-114 days) following knee arthroplasty (HR=1.60; 95% CI, 1.37-1.87; P<.001). After adjusting for age, pathogen virulence and the surgical volume of the hospital, there remained a significantly shorter time to diagnosis of invasive SSI for hip arthroplasty vs. knee arthroplasty (adjusted HR=1.51; 95% CI, 1.28-1.78; P<.001).
According to the researchers, these findings are counterintuitive, since knee joints have less surrounding soft tissue and are more easily accessed for diagnostic testing. They added that further research on this topic is warranted.
“Symptom manifestation and interpretation in hip and knee arthroplasties as well as certain social factors including mobility, access to care, and functional status may contribute to our observation,” the researchers wrote. “Early diagnosis and intervention are critical for the treatment of prosthetic joint infection. Therefore, our findings and hypotheses warrant validation and testing in other prospective cohorts.”
Disclosure: The researchers report no relevant financial disclosures.
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