New study reports fivefold increase in 10-year risk of death after periprosthetic joint infection.
Patients who develop periprosthetic joint infection (PJI) after hip replacement surgery are at substantially increased risk of death in the ten years following surgery, reports a new study in JBJS. Access the study at JBJS.org, along with a video abstract of the findings:
Mortality is about five times higher in patients with PJI after total hip arthroplasty (THA), as compared with matched patients without PJI, according to the new research led by Drs. Raman Mundi and Bheeshma Ravi of University of Toronto. The findings “underscore the importance of prioritizing efforts related to the prevention, diagnosis, and treatment of PJIs,” the researchers write.
New Evidence on PJI-Related Mortality After Hip Replacement
PJI is a “dreaded and unpredictable” complication of THA, in which an infection occurs around the joint implant (prosthesis). Even after revision surgery and prolonged antibiotic treatment for PJI, patients remain at risk of lasting health problems and disability. Previous reports have suggested that PJI might affect long-term survival, although these studies have had significant limitations.
Dr. Mundi and colleagues used Ontario health databases to assess the risk of death associated with PJI in 175,432 patients who underwent THA between 2002 and 2021. Fifty-five percent of patients were women; the average age was 67 years. Risk of death over ten years’ follow-up was compared for patients with and without PJI, matched for age, sex, obesity, and other health factors affecting infection or mortality risk.
Within the year after hip replacement, 868 patients developed PJI requiring repeat surgery, a rate of 0.49%. Patients who developed PJI had higher rates of obesity, frailty, and several other health conditions, consistent with previous studies of PJI risk factors.
On comparison of the matched groups, 11.4% of patients with PJI died during long-term follow-up compared to 2.2% for those without PJI. With adjustment for other factors, mortality risk was 5.5 times higher for patients with PJI.
‘Call to Action’ for Research on PJI Prevention and Treatment
The finding of an increased risk of death associated with PJI is especially relevant because of the continued increases in THA procedures per year in the U.S., with an estimated 600,000 procedures expected to be performed annually by 2030. Despite recognition of the devastating impact of PJI, there is limited evidence on how best to prevent it—and even on the effectiveness of current preventive measures.
The researchers cite several reasons to suspect a causal relationship between PJI and the observed increase in mortality risk. The new population-based study—including long-term follow-up of matched groups of patients—is the largest analysis to date of patients developing PJI after THA. Dr. Mundi and co–authors conclude: “These findings should help to bolster efforts related to the prevention, diagnosis, and treatment of PJIs, which may be considered among the most important priorities for future musculoskeletal research.”
In an accompanying editorial, JBJS Editor-in-Chief Mohit Bhandari, MD, PhD, notes that the observed increases in mortality among patients with PJI are comparable to those associated with common cancers or heart disease—risks that the “vast majority” of patients will be unaware of. “Although this study is not without limitations,” Dr. Bhandari writes, “it helps to shed light on the devastating complication of PJI following joint replacement surgery—and serves as a call to action to researchers to design, execute, and disseminate high-quality studies on PJI prevention and treatment.”
Access the study and video abstract at JBJS.org: Association Between Periprosthetic Joint Infection and Mortality Following Primary Total Hip Arthroplasty
Read the editorial by Dr. Mo Bhandari: Periprosthetic Joint Infection and Mortality. A Call to Action
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