What’s New in Musculoskeletal Infection 2023

The new JBJS Guest Editorial “What’s New in Musculoskeletal Infection” presents findings related to chronic periprosthetic joint infection, oral antibiotic prophylaxis, and more. Here, we highlight the 6 most impactful studies, as selected by co-author Jesse E. Otero, MD, PhD. 

Prevention 

Researchers examined the relationship between prior bariatric surgery and postoperative complication and implant survivorship rates following primary total knee arthroplasty (TKA). Notably, patients who underwent bariatric surgery prior to TKA had higher rates of infection-related reoperation than a matched cohort with high body mass index and no prior bariatric surgery¹. These findings suggest that “underlying malnutrition may play a role,” according to Guest Editorial authors Dr. Otero et al.  

The rates of postoperative periprosthetic joint infection (PJI) were assessed in a retrospective study of 15,825 patients who underwent total joint arthroplasty and received aspirin for venous thromboembolic prophylaxis. PJI rates were compared between patients who took a lower dose of aspirin (81 mg twice daily) and those who took a higher dose (325 mg twice daily). The rate of PJI was higher among patients who took the higher-dose aspirin than among those who took the lower dose (0.35% versus 0.10%, p = 0.001)². 

Surgical Treatment

A multicenter study investigated the long-term reinfection and mortality rates for patients treated with 2-stage exchange knee arthroplasty for chronic PJI. The investigators found an infection eradication rate of 89% among 118 patients with a minimum follow-up of 5 years. However, a high mortality rate of 33% was also reported for this cohort³. 

The role of antibiotic cement spacers in the development of acute kidney injury (AKI) was examined in a prospective randomized controlled trial comparing the incidence of AKI following the first stage of a planned 2-stage exchange vs. a 1-stage exchange for the treatment of PJI. Significantly higher rates of AKI were found in the planned 2-stage group compared with the 1-stage group (22.7% vs. 6.6%; p = 0.011). The authors concluded that the use of a high-dose antibiotic cement spacer is an independent risk factor for AKI⁴. 

Antibiotic Therapy

In a study of 904 aseptic revision TKAs, extended oral antibiotic prophylaxis (mean duration, 11 days) was associated with a 7-fold decreased risk of any infection at 90 days⁵. However, a separate study of aseptic revision total hip arthroplasty by the same investigators found that the extended antibiotic regimen was not associated with a decreased risk of infection⁶. 

“What’s New in Musculoskeletal Infection” is freely available at JBJS.org. 

What’s New by Subspecialty

Each month, JBJS publishes a review of the most pertinent studies from the orthopaedic literature in a select subspecialty. To read the reports, visit the “What’s New by Subspecialty” collection at JBJS.org. 

Recent OrthoBuzz posts include: “What’s New in Orthopaedic Trauma,” “What’s New in Spine Surgery,” and “What’s New in Foot and Ankle Surgery.” 

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References 

1. Ryan SP, Couch CG, Duong SQ, Taunton MJ, Lewallen DG, Berry DJ, Abdel MP. Does bariatric surgery prior to primary total knee arthroplasty improve outcomes? J Arthroplasty. 2022 Jun;37(6S):S165-9. 
2. Najafi F, Kendal JK, Peterson NV, Ciesielka KA, Restrepo C, Parvizi J, Bernthal NM. Low-dose aspirin for venous thromboembolism prophylaxis is associated with lower rates of periprosthetic joint infection after total joint arthroplasty. J Arthroplasty. 2022 Dec;37(12):2444-2448.e1. 
3. Kildow BJ, Springer BD, Brown TS, Lyden ER, Fehring TK, Garvin KL. Long term results of two-stage revision for chronic periprosthetic knee infection: a multicenter study. J Arthroplasty. 2022 Jun;37(6S):S327-32. 
4. Valenzuela MM, Odum SM, Griffin WL, Springer BD, Fehring TK, Otero JE. High-dose antibiotic cement spacers independently increase the risk of acute kidney injury in revision for periprosthetic joint infection: a prospective randomized controlled clinical trial. J Arthroplasty. 2022 Jun;37(6S):S321-6. 
5. Bukowski BR, Owen AR, Turner TW, Fruth KM, Osmon DR, Pagnano MW, Berry DJ, Abdel MP. Extended oral antibiotic prophylaxis after aseptic revision TKA: does it decrease infection risk? J Arthroplasty. 2022 Aug;37(8S):S997-1003.e1. 
6. Bukowski BR, Owen AR, Turner TW, Fruth KM, Osmon DR, Pagnano MW, Berry DJ, Abdel MP. Extended oral antibiotic prophylaxis after aseptic revision total hip arthroplasty: does it decrease infection risk? J Arthroplasty. 2022 Dec;37(12):2460-5.