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Risk calculator identified several risk factors for development of PJI after TJA
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A validated, preoperative risk calculator identified several risk factors for the development of periprosthetic joint infection after total joint arthroplasty. These risk factors included prior surgical procedures and high-risk comorbidities, according to results published in The Journal of Bone and Joint Surgery.
To establish a periprosthetic joint infection (PJI) risk calculator, Javad Parvizi, MD, FRCS, and colleagues used a multivariate analysis in which coefficients were scaled to produce integer scores to evaluate 42 risk factors, including patient characteristics and surgical variables, among 27,717 patients who underwent TJA from 2000 to 2014. Of these patients, 1,035 had confirmed PJI. To perform external validation, researchers used data for 29,252 patients who underwent TKA at an independent institution.
Results showed 25 of the 42 risk factors were not significant risk factors for PJI. Of the 17 risk factors remaining, researchers found a previous open surgical procedure, drug abuse, a revision procedure and HIV/AIDS were the most influential. An internal validation model showed an area under the curve of 0.83 for any PJI, of 0.86 for antibiotic-resistant PJI and of 0.86 for S. aureus PJI. Researchers also found areas under the curve of 0.84, 0.83 and 0.73 for any PJI, antibiotic-resistant PJI and S. aureus PJI, respectively, for external validation. Results showed the lowest decile of risk scores had a rate of PJI of 0.56% in internal validation and of 0.61% in external validation, while the highest decile of risk scores had a rate of PJI of 15.85% in internal validation and of 20.63% in external validation.
“Identifying patients who are at risk of infection after joint replacement is an important task. It allows the orthopedic community to defer surgery in these patients while optimizing the underlying conditions that exposes the patients to the risk of infection,” Parvizi told Healio.com/Orthopedics. “Having a risk calculator will allow us to deliver targeted and individualized care to our patients.” – by Casey Tingle
Disclosures: Parvizi reports he receives non-financial support from Pfizer; personal fees from Zimmer Biomet, ConvaTec, TissueGene, CeramTec and Ethicon; other support from Eastern Orthopaedic Association, Muller Foundation, United Healthcare, Parvizi Surgical Innovations, Hip Innovation Technology, CD Diagnostics, CorenTec, Alphaeon, Joint Purification Systems, Ceribell, MedAp, MicroGenDx, Cross Current Business Intelligence, Invisible Sentinel, Physician Recommended Nutriceuticals and Intellijoint; personal fees from Corentec, Datatrace and SLACK Incorporated; patents 9,384,328, WO2015164188A1, Advanced Biomaterials and Methods of Attaching Therapeutic Agents Thereto, WO2010036930A1 and Diagnosis and Treatment of Arthrofibrosis Diseases; and pending patents on implants for hip arthroplasty and methods of use thereof and methods utilizing D-dimer for diagnosis of periprosthetic joint infection. Please see the full study for a list of all other authors’ relevant financial disclosures.
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