Synchronous periprosthetic joint infections associated with high mortality rate at 1 year
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SAN DIEGO — Results presented at the American Academy of Orthopaedic Surgeons Annual Meeting showed an association between synchronous periprosthetic joint infections with a high mortality rate at 1 year.
Elizabeth Gausden, MD, and colleagues identified 34 patients treated for periprosthetic joint infection (PJI) in more than one joint within a single 90-day period between 1990 and 2019. Most synchronous PJIs occurred in patients who underwent bilateral total knee arthroplasty, according to Gausden.
“There were three bilateral total hips, one patient with a combination total knee and total shoulder, one total hip and total shoulder, one total knee and total elbow, and then one patient who unfortunately had bilateral hips and bilateral knees infected simultaneously,” Gausden said in her presentation.
Gausden noted 65% of the patients were immunocompromised for type B hosts and 13% were immunocompromised for type C hosts. Initial treatment for synchronous PJIs included irrigation and debridement with component retention for all involved joints in 23 patients, implant resection and antibiotic spacer placement in 10 patients, and a combination approach with one joint irrigated and retained and the other joint resected in one patient.
“Unfortunately, we found a severely high mortality rate in this group of 18% within 30 days and 27% within 1 year,” Gausden said.
Gausden noted all of the patients who died within the first 30 days were immunocompromised. She added rheumatoid arthritis was a significant risk factor for early mortality.
“There was a high subsequent incidence of reinfection of at least one joint, which was 13% of cases, at 1 year and 27% at 5 years,” Gausden said.
Patients also had a high rate of reoperation, with one-quarter of patients undergoing reoperation within 1 year and 35% of patients within 5 years, according to Gausden. Gausden noted patients had a high rate of medical complications, with 35% of patients requiring ICU stays and acute kidney injuries occurring in 9% of patients. She added one patient experienced myocardial infarction and one patient experienced a stroke.
“Of the 28 patients who survived beyond 30 days, just about half of these patients retained all of their original implants, or 54%, 23% of patients ended the study with all of their joints successfully reimplanted, 15% of patients had all joints resected and 15% of patients had some combination,” Gausden said.
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Gausden E, et al. Paper 014. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting. Aug. 31- Sept. 3, 2021; San Diego.
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