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Infection in one prosthetic joint can lead to infections in others
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SAN DIEGO — A previously aseptic joint is at increased risk for infection when another prosthetic joint becomes infected, according to results of a study presented here.
 S. Mehdi Jafari |
The findings were presented by S. Mehdi Jafari, MD, at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons.
Jafari reported the risk of periprosthetic joint infection at his institution remains below 1%, but added that those patients who do sustain a periprosthetic joint infection often have another prosthesis in place. The purpose of the study, therefore, was to determine if patients who sustain such an infection are at a higher risk for developing infection in other prosthetic joints.
“It is always a concern that patients may develop a periprosthetic joint infection in the other coexisting aseptic joints when one becomes infected,” Jafari said.
The investigators used their prospective institutional database to review patients with periprosthetic joint infections who had other prosthetic joints in place at the time of presentation from 2000 to 2009. They found 55 patients with a mean age of 62.7 years.
This cohort, Jafari noted, consisted of nine patients with ipsilateral joint replacements, 37 with multiple knees, 17 with multiple hips and nine with a contralateral hip and knee.
Jafari reported five patients had three joints replaced, and two patients had all four joints replaced. Out of the 55-patient cohort, 11 (20%) developed infections in multiple joints. Eight of these 11 patients had multiple knee infections, two had multiple hip infections, and one had an ipsilateral joint infection. Five of these infections, Jafari said, were separated by less than 6 months. Three, he added, were simultaneous.
“An infection rate of 20% is significantly higher than an institutional infection rate,” Jafari said. “With this higher risk for developing periprosthetic joint infection, symptomatic joints should be closely monitored with suspicion for infection.”
Reference:
- Jafari SM, et al. Periprosthetic joint infection: Are patients with multiple prosthetic joints at risk? Paper 125. Presented at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons. Feb. 15-19, 2011. San Diego.
It is an important article and gives us a number to use when looking at the risk of metachronous joint infection, from one joint infection to another prosthesis when one is infected. There are several things that are interesting. One is, these patients did not always develop an infection right away. I think the average was just under 3 years, so that tells you that the host is compromised in some way, or there is something that is causing repetitive bacteremias to seed these other prosthetic joints.
Additional information we would like that they were not able to address was, they said we should “monitor our patients closely” … I am not sure what monitoring means. Does that mean patients should have their joints aspirated, which then raises the risk of causing an infection at the time of the aspiration? Should they just be followed clinically? I think hopefully in time they will be able to answer those questions too.
– Kevin L. Garvin, MD
Professor and Chair
Department of Orthopaedic Surgery and Rehabilitation
University of Nebraska College of Medicine
Disclosure: He receives royalties from and is an employee of Biomet, is a speakers bureau member or does paid presentations for Convatec, and receives royalties or financial or material support from Wolters Kluwer Health – Lippincott Williams & Wilkins.
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