PJI within One Year of Primary TKA Is Associated with Increased Mortality Risk at 10 Years

Seper Ekhtiari, MD, MSc, FRCSC shares investigative insights into a new study in JBJS: Periprosthetic Joint Infection Following Total Knee Arthroplasty Is Associated with a Significantly Elevated Risk of Mortality. A Population-Level Database Study. This post is part of the OrthoBuzz “Author 360” series presenting authors’ perspectives on their work.

Periprosthetic joint infection (PJI) remains one of the most devastating complications in arthroplasty—not only because of the burden it places on patients and health-care systems, but because of the growing recognition that its impact may extend far beyond the joint itself. Our involvement in this work stemmed from a desire to better understand the long-term consequences of PJI after total knee arthroplasty (TKA), particularly whether these infections influence survival years after the index procedure. Our previous work in total hip arthroplasty had suggested a concerning association between early PJI and increased long-term mortality, and we wanted to determine whether a similar pattern existed in knee arthroplasty.

Using a large, population-level database from Ontario, Canada, we found that patients who developed PJI within 1 year following primary TKA had more than a 4-fold increased risk of death at 10 years postoperatively compared with matched patients who did not develop infection within 1 year. Importantly, this association persisted across multiple sensitivity analyses, including younger patients and surgeon-matched cohorts. While the absolute mortality risk remained relatively low, the magnitude of the difference highlights that PJI is not simply a surgical complication with short-term consequences—it may represent a major long-term health event. As well, the mortality risk was on par with some adult cancers. Read the study.

This article is particularly timely as arthroplasty volumes continue to rise globally and patients live longer with implanted prostheses. At the same time, PJI is the leading cause of revision TKA, with substantial economic, physical, and psychological consequences. The orthopaedic community has made major advances in the prevention, diagnosis, and treatment of other complications, but major advances in PJI management remain difficult and elusive.

More broadly, this study contributes to a growing body of literature suggesting that complications after arthroplasty can have lasting systemic effects. The combination of this study with our previous work on mortality following hip PJI points clearly to a need for international, collaborative efforts aimed at a better prospective understanding and study of PJI, including prevention, diagnosis, and treatment.

Seper Ekhtiari, MD, MSc, FRCSC is a fellowship-trained orthopaedic surgeon specializing in complex hip and knee replacement at Sinai Health System in Toronto, and an Assistant Professor in the Division of Orthopaedics, Department of Surgery, at the University of Toronto, Toronto, Ontario, Canada.