Author(s): Luis Pulido*, Javad Parvizi, Elie Ghanem, Ashish Joshi, Peter F. Sharkey, Richard H. Rothman; Rothman Institute, Philadelphia, PA
Title: Predictors of Periprosthetic Joint Infection
Purpose: Periprosthetic infection (PPI) is one of the most challenging complications of joint arthroplasty. This study intends to elucidate the incidence of PPI and identify predisposing factors for PPI after primary joint replacement.
Methods: We performed a cohort study using prospectively collected data from our institutional arthroplasty complication database. We include 9,247 patients who underwent primary hip or knee arthroplasty from January 2001 to December 2006. PPI developed in 63 patients (0.7%). Numerous variables including gender, age, ethnicity, ASA score, operative time, pre and postoperative labs (hemoglobin, INR, creatinine, WBC, glucose), patient comorbidities and perioperative complications were evaluated.
Results: The majority of PPI developed within the first year following index arthroplasty. After unadjusted analysis we found that race, higher BMI, knee arthroplasty, simultaneous bilateral surgery, higher ASA score, longer operative time, higher postoperative creatinine, higher postoperative glucose level, comorbid anemia, hypercholesterolemia, rheumatoid arthritis, previous thromboembolic disease, perioperative atrial fibrillation, wound drainage, hemarthrosis, myocardial infarction, urinary tract infection and wound infection were significant variables associated with PPI. Following logistic regression analysis, to adjust for potential confounders, only race (Hispanics), higher ASA, simultaneous bilateral surgery, postoperative atrial fibrillation, myocardial infarction, and urinary tract infection remained as significant predisposing factors for PPI following joint replacement.
Discussion: This large cohort study confirmed some previously implicated factors and identified new significant variables that result in development of PPI. Understanding these risk factors will help institute strategies for a better approach to prevent this undesirable complication.